Learn about six of the latest trends in health care and the leading Valley doctors who perform them
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Two new steps to healthy feet
Toe fungus: It’s ugly. It’s unhealthy. “And it’s so prevalent that about 30 million people in the U.S. have it,” says podiatrist Dr. Tracey Toback, D.P.M. The common condition causes the toenail — most often on the big toe — to become hard, brittle, and yellowish. “It’s embarrassing, too. People often try to keep their toes covered up all the time, women may keep applying polish to try to hide it,” he says.
But foot fungus isn’t just a cosmetic issue. “If a person has diabetes, which can affect circulation, they may already have foot problems, and any kind of infection such as this can make matters worse,” he says.
Why is toe fungus so widespread? “The number one reason is because athlete’s foot is so common; the fungus first gets on the skin, then spreads under the nails,” Toback says. Athlete’s foot is frequently found in moist places like gym shower areas and locker rooms — and is quite contagious.
Second, folks tend to torture their tootsies. “People damage the nails, especially on the big toe,” says Toback, a board-certified foot surgeon whose main office is in Highland. “They wear tight shoes. They accidentally drop things on their toes; they kick things with their toes.” All this causes the nail to lift slightly off the nail bed. “Then fungus can get in underneath and start spreading,” he explains.
The most common antifungal treatments available today are topical creams and pills. “Creams often soften the nail, but don’t usually really get rid of the problem. And pills need to be taken under supervision; some can adversely affect the liver,” says Toback.
But now there’s another option — podiatrists can use a laser to blast that nasty fungus into smithereens. “It’s an infrared laser beam that passes harmlessly through the nail and actually vaporizes the fungus cell membrane that’s embedded under the nail,” says Toback. The procedure is done in one session, he adds, usually taking about 10 minutes to treat a big toe; and half an hour to tend to all 10 nails if needed — without pain, drugs, or anesthesia.
“Our clinical studies to date show that more than 88 percent of treated patients show significant improvement,” he says. “In most cases, the fungus is completely cured.”
Another promising breakthrough treatment can be a boon for patients with arthritis in the big toe. “This type of arthritis is similar to a bunion — when a toe joint is misaligned,” Toback says. With a typical bunion, the toe is displaced outwardly. In the case of an arthritic bunion (or arthritis in the big toe), the deformed toe tends to bulge upward.
Arthritic bunions often result from one of two causes, Toback says. “It might be due to an undiagnosed or untreated fracture of the big toe — because the toe wasn’t immobilized in order for it to heal, the bone tried to repair itself anyway and grew out of alignment.” This can cause damage to the cartilage, resulting in both misalignment and pain. Poor alignment of the toe joint can also be hereditary, he says.
Either way, for patients with arthritic big toe joints, the most common treatment has been joint fusion, in which the end of two toe bones are surgically joined. “The problem with a fusion is that the joint is no longer mobile. Also, you have to keep it in a cast for up to six weeks, without walking on the area.”
But a new technique known as the Hemicap implant allows patients to keep their ease of mobility, says Toback. “First, a small titanium screw is inserted into the bone of the toe, then a tiny cobalt chromium cap with an interlocking notch is attached on the end. Basically you’re screwing in the implant.” With a traditional implant, he says, stem-like supports would be put into the joint, and they could sometimes break or shatter — and didn’t provide mobility. The Hemicap procedure is FDA-approved for use in the shoulder, hip, and foot. “The beauty of it is that it acts like a rounded ‘cap’ that offers full mobility of the joint. You can even walk on it immediately,” he says.
Tracey Toback, D.P.M.
Toback Podiatry, 845-339-FEET