3 Myths about Ingrown Nails:

1) Ingrown nails can be treated with a PEDICURE.

As the image above shows, some patients will develop a deformity of the edge of the nail which extends underneath the skin and leads to pain and puncture of the skin eventually leads to infection. A pedicure only treats the exposed nail, and they are generally not able to relieve the symptoms entirely because of sensitivity to the area. In most cases, it is required to use local anesthetic to completely allow access to this painful area and this can only be accomplished in the office of a trained medical professional.



2) Ingrown nail surgery is painful.
It is actually more painful to allow this infection to become what is shown by the clinical picture above. This sort of infection is more painful secondary to the pressure from the underlying purulence, and pressure from the nail tissue pressing into the surrounding skin. After your procedure is completed, you will leave the office in no pain and after the lidocaine wears off, the pressure and sharp pains you were experiencing prior to the intervention will be minimal, and in most cases can be relieved by over the counter Alleve medication or variant.




3) After nail surgery my nail will be narrow

This is immediately after the nail is removed post procedure. The reddened area is raw tissue which is exposed post partial matrixectomy and prior to the chemical cauterization. As you can see, the nail that is visible is very normal looking, and most of the nail which is removed is not usually visualized as it is beneath the skin layer.


After several weeks, the nail tissue will heal, and the new nail border will attach to the side and appear very natural. In this clinical example it is the same procedure just a few weeks after, and the area that looks like a deficit in skin will fill in over time and the new nail fold will attach without any further intervention.


Brian Timm, DPM, FACFAS
Diplomate American Board of Podiatric Surgery 

My Ankle Hurts !! Chronic ankle pain and you.

Chronic lateral ankle pain symptoms

Chronic lateral ankle pain is characterized by swelling and stiffness near the ankle joint, as well as recurring pain on the outside of the ankle that worsens with exercise. The pain can be brought on by walking and playing sports, or it can manifest as a dull and constant ache. One of the more distressing symptoms of chronic lateral ankle pain is a constant feeling of ankle instability. People with chronic lateral ankle pain often have difficulty walking in high heels or on uneven ground and are prone to repeat ankle injuries.

Treatment of chronic lateral ankle pain 

Treatment for chronic lateral ankle pain will depend on the final diagnosis by your physician. Conservative treatments include:
Ankle brace (to fascillitate immobilization and prevent further injury).
Ankle arthroscopy (surgical exploration and repair of damaged cartilage)
Anti-inflammatory medication (to reduce swelling).
Physical therapy (designed to strengthen muscles and restore joint motion).
PRP injections (Natural autograft to enhance isolated tendon healing)
MRI examination (Typically for surgical planning to see the extent of the damage and planning for open repair)

Not all pain is arthritis based. And not all pain is attributable to a definitive trauma or injury. The history of chronic ankle pain and instability is usually multifactorial, and is often under treated and not diagnosed very well which may lead to tendon tears and progressive degenerative arthrosis. We will perform a complete examination which will allow for more accurate diagnosis and improved prognosis.

Dr Timm
Diplomate American Board of Podiatric Surgery

Does weather worsen arthritis?

"Doc, my ankles hurt more in the cold. Why is that?"

I get this question often from patients who are seasonally living in this area.

But does the weather actually affect arthritis? If so, how?

First, there hasn't been much real research science addressing this question. In 1961, famous arthritis specialist J. Hollander, MD, conducted a study in which he built a climate chamber and demonstrated that high humidity combined with low barometric pressure were associated with increased joint pain and stiffness. Neither weather factor by itself seemed to influence joint symptoms. The study has been criticized because of the limited number of patients evaluated (12 patients). The theory of the study is that inflamed joints swell as the barometric pressure drops. This swelling irritates the nerves around the joints that sense pain and causes more stiffness.

Well, if this theory proved correct (and it is not universally accepted), should a person with arthritis move to a region with a dry climate?

The answer is no. Relocating to a different climatic environment does not seem to make a difference in the long run. Scientific studies have shown that no matter where people live their bodies seem to establish a new equilibrium to the local climate. As a result, changes in the weather affect the arthritis symptoms in the same manner regardless of the actual overall average weather. Moving is not likely to be beneficial long term. (To emphasize a point, I can tell you that there are plenty of busy rheumatologists in Florida!)

What is the bottom line?

It appears that there is some evidence that the symptoms of certain people with arthritis are influenced by changes in the weather. This is not true for all people with arthritis, nor is it predictable what type of weather alterations will bother people. For example, in one room I may have a patient complaining that last week, just before it rained, her joints began aching and now that the weather is warm and clear she feels better. Simultaneously, in the next room, a patient tells me that her joints are far worse today after it rained last week! What do I do with this information? Well, each patient must be evaluated (and evaluate themselves) uniquely. The bottom line is that while the exact cause(s) of the activation of arthritis symptoms may not yet be scientifically understood, each patient must make lifestyle and/or medication adjustments according to the particular weather conditions that they note influence their symptoms.

If a patient does experience joint pain and stiffness with weather changes, how harmful is this?

It is very important to appreciate that only joint symptoms (such as pain and stiffness) are influenced by weather. We do not have any evidence that weather changes lead to joint damage. Furthermore, weather changes have not been related to whether or not an individual develops arthritis.

So enjoy the warmth while you're here, and remember to bundle up if you are still in the cold, as this may otherwise precipitate painful swelling and stiffness of your joints. 

Flatfeet could slow you down

How is this possible?

The results conducted by the American Podiatric Medical Association concluded that a staggering 73 percent of people asked said that they are suffering from foot pain.

The question is: why has foot pain become one of the most common complaints in the examination room?

For many people, this problem can be caused by one of the following: the kinds of shoes they wear, what activities they participate in, or how their feet are formed. Wearing poorly-fitting shoes can turn minor problems into major ones. People who engage in athletic activities are another segment of the population that are mostly affected by foot pain. Factors such as fallen arches, overpronation, and poor support can all be contributing factors to lower extremity pain. Parents can also be the cause of foot-related problems, because genetics play a role how the foot was formed in the womb. This can enhance the likelihood that someone will suffer from an array of painful foot conditions.

The Mechanics of the Foot
Flat feet can cause abnormal rotation of the feet when walking or running. Our feet handle balance, stability, and bear the weight of the body. The parts of the foot that help to keep the foot in harmony with the body include the arch, heel, tarsals and meta-tarsals. The arch provides stability by the following structures: the tendons, ligaments, and muscles. Pain can result from raised arches or abnormally-low arches, which can cause the foot to rotate abnormally. With high arches, the body’s weight is abnormally emphasized on the outer edge of the foot (oversupination). Conversely, overpronation happens with fallen arches because the weight of the body is concentrated on the inside of the foot, causing the ankles to roll inward .

Serious Foot Issues May Occur with Flat Feet A quick way to see if fallen arches or high arches are an issue is to find a good area where a foot impression can be made, such as on concrete. Immerse on foot in cold water and then stamp your foot onto the dry surface. Then, lift the foot off the ground and see the impression that is left by the foot. A flat foot with overpronation will leave a complete mark where the entire foot has touched the ground. A high arch will leave just a part of the ball of the foot’s outside portion, and heel of the foot. Either of these arch conditions can cause painful bony growths in the heel because the foot has to deal with too much pressure in places it is not intended to handle.

Orthotics Provide Effective Relief for Therapy For Plantar Fasciitis
People suffering from fallen arches, heel spurs, or who need plantar fasciitis treatment can get relief by using the best orthotics available in their shoes. They offer the needed support to fix the weak structures in the foot, such as those that make up the arch. They also offer cushioning in areas where too much pressure occurs, such as in the heel or ball of the foot. Orthotics are available in an array of sizes and types and are made to keep up with anyone’s activity level.