Panhandle Podiatry, PLLC
Dr. John Mollica was born and raised in New York . He received his degree from The New York College of Podiatric Medicine in Manhattan, NY. He began his practice in Elmira, New York before deciding to relocate to Martinsburg in 2001. In 2005, Panhandle Podiatry expanded its services to Morgan County. Dr. Mollica now has two offices in the area and services seven nursing homes and assisted living facilities. He resides in Falling Waters with his wife, Jennifer, and their four children. Susan Bohrer is the Business Manager for Panhandle Podiatry. She works in close partnership with Dr. Mollica to serve our communities needs. Susan came to Berkeley County from New York in 1996. She is a graduate on Long Island University with a BS and BA degrees in Marketing/Management and Health Management with a major in Radiology. She has been with Dr. Mollica since the practice began in West Virginia. Susan resides in Morgan County with her husband, KC. Romayne Inguanti is our front office supervisor. She has been with Panhandle Podiatry since 2001. Romayne is a registered nurse and began by assisting Dr. Mollica with multiple procedures and patient care. In 2005, Romayne moved from patient care to office supervisor. She is happy to assist with scheduling and insurance questions. Romayne resides in Martinsburg with her husband, Sal.
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Ingrown nail |
Onychocryptosis (also known as an "Ingrown nail," and "Unguis incarnatus"[1]) is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with the toenails.
Causes
Causes include:
- bad maintenance [like cutting the nail too short, rounded off at the tip or peeled off at the edges (versus being cut straight across)];[2]
- ill-fitting shoes [those that are too narrow or too short can cause bunching of the toes in the developmental stages of the foot (frequently in those under 21), causing the nail to curl and dig into the skin];
- trauma to the nail plate or toe [which can occur by stubbing the toenail, dropping things on the toe and 'going through the end of your shoes' during sports, can cause the flesh to become injured and the nail to grow irregularly and press into the flesh]; and
- predisposition [abnormally shaped nail beds, nail deformities caused by diseases, and a genetic susceptibility to nail problems can mean a tendency to ingrowth].
Chronically ingrown toenail (that twice had failed wedge resections on both sides)
Symptoms of an ingrown nail include pain along the margins of the nail (caused by hypergranulation that occurs around the aforementioned region), worsening of pain when wearing shoes or other tight articles, and sensitivity to pressure of any kind, even the weight of bed sheets or a duvet. Bumping of an affected toe with objects can produce sharp, even excruciating, pain as the tissue is punctured further by the ingrown nail. By the very nature of the condition, ingrown nails become easily infected unless special care is taken to treat the condition early on and keep the area as clean as possible. Signs of infection include redness and swelling of the area around the nail, drainage of pus and watery discharge tinged with blood. The main symptom is swelling at the base of the nail on whichever side (if not both sides) the ingrowing nail is forming.
The most common place for ingrown nails is in the big toe, but ingrowth can occur on any nail. Ingrown nails can be avoided by cutting nails straight across; nails should not be cut along a curve, nor should they be cut too short. In both cases, the important thing to avoid is cutting the nail shorter than the flesh around it. Footwear which is too small, either in size or width, or those with too shallow a 'toe box' will exacerbate any underlying problem with a toenail.
It may not be so critical that the nails be cut perfectly 'straight across' as this may imply that they be squared at the corners. Leaving sharp square corners may be uncomfortable and cause snagging on socks. The important thing to keep in mind is that you want to be able to 'SEE' the corners. You should be able to see the side edge of the nail as it meets the front edge of the nail. This way, you can be sure there is no 'splinter' veering off to the side and growing into your toe. Careful filing of the corner is reasonable. For some people the nail curves down on the sides, in this case it would be difficult to ever see the side edge of the nail plate and this cutting method does not apply. Some nails require cutting of the corners far back to remove the edge that digs into the flesh, this may be done as a partial wedge resection at your podiatrist's office.
Ingrown toe nails can be caused by injury, commonly blunt trauma where the flesh is pressed against the nail causing a small cut that swells. Also, injury to the nail can cause it to grow abnormally, making it thicker or wider than normal or even bulged or crooked. Stubbing the toenail, dropping things on the toe and 'going through the end of your shoes' in sports are common injuries to the digits. Injuries to the toes can be prevented by wearing properly fitting shoes, especially when working or playing.
One myth is that a V should be cut in the end of the ingrown nail; this myth is untrue. The reasoning of the myth is that if one cuts a V in the nail, the edge of the nail will grow together as the nail grows out. This does not happen - the shape of the nail is determined by the growing area at the base of the toe and not by the end of the nail. A notch does no good, and may do harm if it is cut too deeply.
Treatment of ingrown nails ranges from soaking the afflicted area to surgery. The appropriate method is dictated by the severity of the condition. In nearly all cases, drainage of blood or watery discharge should mean a trip to the doctor, usually a podiatrist, a specialist trained explicitly to treat these conditions. Most practitioners agree that trying to outwait the condition is nearly always fruitless, as well as agonizing.
Fungus
Athlete's foot and fungal nails are the most common types of foot fungus.
Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus usually attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.
The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi.
Not all fungus conditions lead to Athlete's foot, however. Other conditions, such as malfunctions of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic Athlete's foot.
Symptoms of athlete's feet include drying skin, itching scaling, inflammation, and blisters. Athlete's foot may spread to the soles of the feet and to the toenails, and can spread to other parts of the body, including the groin and underarms.
You can prevent Athlete's foot by:
· Avoiding walking barefoot. Use shower shoes. · Reducing perspiration by using talcum powder. · Wearing light and airy shoes. While fungicidal and fungistatic chemicals are usually used to treat Athlete's foot problems, they often fail to contact the fungi in the horny layers of the skin. Instead, topical or oral antifungal drugs may need to be prescribed. · Exercise proper hygiene and regularly inspect your feet and toes.
· Keep your feet clean and dry.
· Wear shower shoes in public facilities whenever possible.
· Clip your nails straight across so that the nail does not extend beyond the tip of the toe.
· Use a quality foot powder - talcum, not cornstarch - in conjunction with shoes that fit well and are made of materials that breathe.
· Avoid wearing excessively tight hosiery, which promotes moisture. Acrylic socks tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.
· Disinfect home pedicure tools and don't apply polish to nails suspected of infection.
Over-the-counter liquid antifungal agents, while sometimes effective, may not prevent a fungal infection from recurring. I may prescribe a topical or oral medication, and removal of diseased nail matter and debris (debridement).
· Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.
Fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish, but it can present serious problems if left untreated.
Also referred to as onychomycosis, fungal nail infections are an infection underneath the surface of the nail, which can also penetrate the nail. In addition to causing difficulty and pain when walking or running, fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.
A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail's protein substance. When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.
Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's foot and excessive perspiration.
You can prevent fungal nail infections by taking these simple precautions:
In some cases, surgical treatment is prescribed, during which the infected nail is removed. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.
Warts · Avoid direct contact with warts - from other persons or from other parts of the body.
· Avoid walking barefoot, except on sandy beaches.
· Change your shoes and socks daily.
· Check your children's feet periodically.
· Keep your feet clean and dry.
Over-the-counter foot wart treatments are usually ineffective because their use can inadvertently destroy surrounding healthy tissue. Our practice can treat warts a variety of ways, including medication and laser cautery.
Most foot warts are harmless, even though they may be painful. They are often mistaken for corns or calluses - which are layers of dead skin that build up to protect an area which is being continuously irritated. A wart, however, is a viral infection.
More serious foot lesions such as malignant lesions can sometimes be mistaken as a wart. Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.
Plantar warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole are properly called plantar warts.
Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.
The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public bathing facilities.
If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
Plantar warts that develop on the weight-bearing areas of the foot - the ball of the foot, or the heel, can cause sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.
Diabetes and Your Feet
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.
With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.
Here's some basic advice for taking care of your feet:
· Always keep your feet warm.
· Don't get your feet wet in snow or rain.
· Don't put your feet on radiators or in front of the fireplace.
· Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
· Don't soak your feet.
· Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
· Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
· Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
· Wash your feet every day with mild soap and warm water.
· Wear loose socks to bed.
· Wear warm socks and shoes in winter.
· When drying your feet, pat each foot with a towel and be careful between your toes.
· Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely.
· Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.
The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is an another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.
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