One month into the fall soccer season and I want to burn my daughter's soccer cleats!!!!

This is the time of year that I can not help but wonder, what after school activity could my child do that would not effect the smell on the inside of my car.  A couple of things come to mind: Mathletes, drama, choir...I guess there are many more but she loves soccer! (Good parent disclaimer: our kids play sports and instruments before I get comments on not focusing on the arts) She loves soccer so much that she apparently can not smell the noxious fumes that come from her lower legs and cleats.

I have chosen my car this past week over my child's smell and lower limb safety.  I purchased the 2 gallon zip-lock bags and I make her double bag her cleats and her shin guards until we get to the field.(I am sure this is on some type of soccer mom life hack website, but my inspiration was a matter of basic quality of life.)  Once we are in the open air, within a reasonable distance from other human beings, she can the start the process of putting her moldy, cruddy shin pads and cleats on then quickly cover them with thick socks so only she then can be affected by her own grossness!

Now as a foot doctor, I think I should have a better way to help my yucky child but I fall short like all busy parents.  Sometimes that drive from the office, which on my days to pick up the kids I get done around 2pm so I can be there for pick up, then homework, feeding, and then the extra-curricular activity, very little time exists to actually use your brain firing on all cylinders!  I am thankful to have a 50/50 partner in my husband(Dr. Henne, the other doctor in the office) so that this way harder job than seeing patients is not my responsibility every day!  We both take turns doing the hardest job there is: coordinating the academic, social, extra-curricular, feeding, hair doing ect.......of three girls under the age of 11.

As I sit here thinking about my smelly child who is soundly asleep and soccer cleats and shin pads securely on the front porch(as a secondary security system, as one whiff and you will not want break in this stinky house). I wonder the best ways to help her and the rest of the world not have to smell the gunk she is incubating weekly with her sweat and tools of nose destruction: cleats and shin pads! I realize I have so many anti-fungal preventive treatments in my office, why don't I put them to the test.  Because I am impatient I will be setting up a prospective experiment with only one test subject, my 10 year old Lily.   I will be spraying her cleats and shin pads daily with an anti-fungal spray I have for shoes in the office and sterilizing her cleats with a steri-shoe(an ultra-violet light that is supposed to kill the fungus molds and spores growing in her shoes).  This study will surely not be published in a peer reviewed journal, but if it works I will be able to help million of soccer, hockey, basketball, football, and well let's face it any parent with a kid with stinky equipment or cleats!

I am starting this "experiment" right now, I am going to give this experiment only until Halloween, in honor of how creepy her cleats truly are.  I hope to make it out alive from this experiment and hoping not to get a rare form of soccer cleat induced lung Aspergillosis.  If you have any life hacks for smelly cleats, please feel free to share under the comments. I will keep you updated weekly and if I think there is a chance in you know what that this will work I will surely let you know! 

The War on Nail Fungus...the many battles you must fight to kill nail fungus!!!

New treatment modalities for different medical conditions come and go. When we first heard about the PinPointe Laser for toenail fungus we were certainly skeptical about it being a miracle cure for fungus.This laser has been available on the market since 2007 and when we first heard of this laser, we thought here goes another trend that will cost the patient a lot of money and won't work. I thought this device would leave as quick as it came. This did not happen, in fact, we started to have patients that we refer to as "Snowbirds" living here in Florida only part time, that had this procedure done up North with great success. Yes they had to wait 9 months or longer to see the return on their investment, but happy when they saw their result. This prompted us to investigate the PinPointe Laser in more depth. At the time, the PinPointe Laser was the only laser built from the ground up to kill nail fungus and was cleared by the FDA based on peer reviewed studies. When introducing a modality into your office for patients, you take a certain leap of faith that what you know from research and speaking to other physicians success stories will translate into success for your patients. 2012 the Center for Ankle and Foot Care introduced to PinPointe Laser for nail fungus into our practice.

We jumped into the laser for nail fungus feet first!(yes pun intended) We acquired our laser in February of 2012. Over the last 2 and 1/2 years we have developed protocols for the laser that work best for different case scenarios.  But before I ever discussed with patients the laser, I give them all of their treatment options.  I first discuss the topical approach, I do explain that topical success rate truly depends on if the fungus is under the nail or on top of the nail.  If the patient has a superficial fungus a topical can be effect.  If the fungus is under the nail, no dice! The thick nail and topical anti-fungal is a wildly unsuccessful combination.

If your nail is thick and fungal, an oral medication can be a treatment option.  Lamisil is the drug of choice.  We get what is called a liver function test, blood work to make sure your liver is free from disease.  If your liver function test is normal, you can take the Lamisil.  I make my Lamisil patients follow all of my laser patients after care.  They have to prevent reinfection with the same steps listed below.

The last option I discuss with patients is the PinPointe Laser treatment.  Some people can not take the medicine by mouth or just do not want to take the medicine by mouth.  They want the laser.

Many patients are interested in having the State of the Art PinPointe Laser Treatment for their discolored, thickened fungal toenails.  Before anyone jumps into having this procedure done, we sit down and explain to them why, what they do at home, is just as important as the Laser treatment itself. Yes the PinPointe Laser for toenail fungus is a great procedure, but patients have to be active in their roll to prevent any reinfection!

How the PinPointe Laser works is simple. This patented laser is specially designed to shine through your toenail and destroy the specific pathogens embedded in and under your nail causing the infection.  Unlike other lasers that are used for skin or pain treatments, the PinPointe™ laser is designed and used for only one purpose; to safely destroy molds and bacteria that cause fungus nail infections (Onychomycosis). If the nails is extremely thick it can take up 15 plus treatments and quite a bit of patience, as it truly takes 9 months to a couple years for a whole new nail to grow out.

Before the patient has the PinPointe Laser performed a thorough evaluation of the skin and nails is performed. If the patient has a bad case of athlete's foot, they will be given a prescription for a topical anti fungal for the skin. I would see them back after a couple of weeks before I would perform the laser treatment. I explain that success is dependent on the foot being in an environment that is free of fungus. If a patient has the PinPointe Laser procedure performed, what they do from that moment on can play a role in their success rate. Once we have performed this procedure, patients are given instructions on preventive care for the toes.

What to Avoid After Having the PinPointe Laser Treatment :

• Any shoes that you have worn before the Laser (especially shoes you have worn without socks)
• Nylons or panty hose
• Going barefoot in environments that could expose you to fungus again
• Pedicures in places that do not AUTOCLAVE instruments and take all precautions to protect you
• Wet moist environmental exposure to feet(ie. constantly having wet shoes) usually occupational hazard

Why it is Important to Avoid these things After The Laser:

• Any shoes that you have worn before the Laser was Performed are basically little incubators for the fungus, putting these shoes back on puts you at risk for reinfection!
• Nylons do not breath, again causing an environment that will be moist and possibly be a red flag for your toes!
• Taking precautions in environments that you are not familiar with is important, if Joe Schmo has fungus and you walk in his house barefoot, you are increasing your chance of reinfection!
• Do not get a Pedicure unless you know: that all instruments are autoclaved, they use liners between each client, that the pedicure chairs are pipeless and tubeless, that they do not reuse any files on anyone and that they do not reuse nail polish from client to client!
• If you are a landscaper, chef or someone whose feet are constantly getting wet at work, you need to change your shoes during the day and even consider spraying your feet with an anti fungal spray during the day while at work!

The laser is not in itself a miracle cure if the patient does not take an active roll in their own care.  The laser can dramatically improve the appearance of the nail and get rid of the fungus, but if you have a nail that has had previous trauma and the nail is deformed you still may wind up with a disfigured nail just fungal free.

   Biggest rate limiting step for patients perceived successful outcome is how slow the nail grows. We do advise those with extremely thick nails, that they will most likely need multiple treatments and recommend our comprehensive care plan of the unlimited zaps until their fungus is gone.  We want people to know if they are serious about getting rid of their nail fungus we have something that actually works and worth the investment for their future good foot health. 

What we charge:
1. If your nails are not thick we recommend the 5 zaps for $500
2. If your nails are thick you should consider the unlimited zaps until your fungus is gone for $1500. We will be with you every step of the way until the fungus is gone!

If you are interested in learning more about the PinPointe Laser Treat for Nail Fungus click the link below. 

 

Fungus Among Us, I mean really in my own home, Mommy Foot Doctor's Worst Nightmare!!!

As I sit and have breakfast with my three beautiful children I reflect on just a couple weeks ago when my oldest asked me to check her feet.  It was 8:30pm when she decided to ask me to give her an impromptu foot exam.  See Lily's bedtime is 8:00 pm, so when she asked for her gratis foot exam I declined:) The next night went very similar to the night before. "Mom! please check my foot", Lily cried at 8:20 pm.  Of course, my mommy, not foot doctor response was, "GO TO BED".  My kids know I love talking feet, but I felt that my very smart 8 year old was trying to manipulate me.

Several days passed and finally my poor Lily said to me at exactly 7:59pm, "Please just take a peek at my toes mommy." I gave in to her request only to discover that:

1. My daughter had Athlete's foot and 2. I am a TERRIBLE MOTHER:)

Now you may insert the music from any horror movie.  I looked in shock at the peeling red skin between all of her toes and on the bottom of her feet. I quickly threw down her covers over her feet and ran to my 7 year olds room. Ripped the sheets off of her feet while she was resting peacefully in her bed.  You may now insert the sound effect of a horror movie scream that went off in my head! My two sweet baby girls had fungus in between all of their toes and on the bottoms of their feet.  Abby, my 7 year old, woke up and said "Yeah, that's been there forever, can you turn out the light."

I scrambled through my house looking for a topical anti-fungal, but much to my dismay, I had none.  What kind of podiatrist doesn't have anti-fungal in their house, right.  Honestly, that is not something you think about keeping in your house on a regular basis.  Both my Lily and Abby are in gymnastics. They go into the gym every time with out shoes and socks and walk several steps outside of the gym barefoot to get their shoes on before leaving the building at the end of practice.  My kids are not immunocompromised, they are not more susceptible to fungus than the next guy, they are normal kids. 

Why them? This is the questions patients ask me all the time when I tell them they have fungus on their skin or nails.  The reality is when you wear an organ on the outside, i.e. your skin, you are exposing it to everything.  Fungus does not discriminate, it does not care if you are young or old, it is out there just waiting for you(insert scary music once more:))!!!

Fungus can thrive for quite some time without a host, it can hang out on some dry skin that has flaked off of someone with a fungal infection.  You then step on the fungal flakes of skin and bam you gots the fungus! But that's not all, if left untreated, like my poor neglected children ( I blame their father, he's a foot doctor too), it can lead to the much more difficult to treat NAIL FUNGUS.  That night I discovered my childrens fungus, I could not sleep at all, I just kept seeing that "Digger the Dermataphyte" lifting up my poor sweet babies toenails. 

The story has a happy ending, as I was able to get an anti-fungal from the office, Clarus Foot Cream, shameless plug, but great product we sell in our office:) In three days it looked better. But I tell all my patients that you always treat skin fungus at least for a week or two longer than you think you have to.  This gives you time to do all the important things like evaluate your shoe gear, throw out whatever is questionable and treat the rest either with spray or SteriShoe.  See once you personally have fungus, skin or nail, the biggest offender for your reinfection is YOU.  The shoes you put back on that have already been exposed to the fungus, the floor surfaces in your house that may have a nice little fungal spot of dead skin waiting to attack, the repeating of PEDICURES in establishments that do not take your health into consideration, these among others are reasons that you should treat athletes foot for a little longer. (Also shameless plug number 2, in our office we have a Safe Pedicure Experience for those who do not want to get nail fungus while getting a pedicure, check us out at  The Natural Nail Spa). And if you are struggling with a nail fungus, taking Lamisil pills by mouth or having the Laser performed, you must continue with a sound preventive program.  It is true that the Laser and Lamisil may increase the nail clear appearance but we tell ALL of our patients that it is so easy to get reinfected.  The patients success is linked and tied closely to them understanding that preventing nail fungus is a life long journey and anti-fungals become a daily occurrence FORVER, to prevent any reinfection.

The reason I even mention nail infections from fungus is because the fungus that commonly causes athletes foot is the same fungus that often cause a toenail fungus.  So if you have athletes foot and no toenail fungus this is a warning, prevention is the best medicine.  I see people on a daily basis who come into my office with ankle sprains, heel pain and other non skin related conditions, many of these people are in shock to find out that they also have athletes foot. But these lucky people are able to treat their condition so it doesn't progress to something worse.

If you are reading this, I would encourage you to check your feet. Inspect the bottoms of your feet, do you see peeling skin in between your toes? Are the soles of your feet peeling? Do you have weird little cracks on your feet? This may be fungus, don't be like my gross, neglected kids, TREAT IT:)

If you know me then you know I have one other child, she was lucky enough to not get the athletes foot in our fungal laden house:) 

But She has her own issues, see below:)

KEEP YOUR FEET HAPPY AND HEALTHY:)  Thank you for taking the time to read our little blog. As always, if you ever have any foot or ankle problems, Dr. Henne and myself are there for you.  If you would like any more information about foot stuff please visit our webpage at centeranklefootcare.com we have tons of information on all different kinds of foot and ankle conditions and information about the PinPointe Laser for Nail Fungus. 

Take Care, 

Dr. McGowan:)