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Monday, November 30, 2015

BIG Toe pain after Thanksgiving feast

You just may have the GOUT.   What is Gout aka Podagra?    Formerly known as the rich man's disease.   Ben Franklin had it, Kings of England had it.    It is typically an overconsumption of "rich" foods such as red meat, turkey, shellfish, and red wine.    Any overload of protein from any source can bring this about.    

Presentation:
inflammation of the big toe or ankle joint with extreme pain and occurs all of a sudden after a heavy protein meal such as thanksgiving.


Can be confused with:
Cellulitis or an infection, they look the same upon presentation and can be confusing. Sometimes, a physician will give medication for both.


How is it diagnosed?
Blood uric acid levels are inaccurate for acute or immediate attacks.
Joint fluid aspiration aka obtaining fluid from the offending joint via a needle will yield the most accurate diagnosis.

How is it treated?
Cortisone injection
NSAIDS
Fluids
Sometimes medication to control the uric acid
Gout vitamins such as GOUTTROL with natural ingredients to help aid in the inflammation control .

See your podiatrist for this for immediate care and relief.



Tuesday, November 24, 2015

2015 Year End Deductibles


It’s hard to believe, but 2015 is almost over! Our end of the year appointments are filling up quickly and we at Family Foot & Leg Center would like to remind our patients that now is a great time to think about the health of your feet. If you have met your deductible, now is the time to schedule your appointment and take action towards a healthy pain free life. Your insurance may cover orthotics, , surgery, and more! Take advantage of your insurance plan by calling our office today to schedule your appointment with one of our doctors before it’s too late. If you are unsure if you have met your deductible, we recommend you contact your insurance provider to determine your remaining allowance for this year. We thank you for your patronage in the past and look forward to continuing to provide you with exceptional foot care in 2016!

Health insurance deductibles are your out pocket expenses that must be met before your insurance company starts to pay.  Therefore, if you have had other procedures done this year or your family members on the insurance plan has had some procedures, your deductibles may be met.  
Deductibles have been on the rise year over year, you should check with your insurance company about such.


 Call our office today at 239-430-3668(FOOT) and we will be sure to schedule your next appointment promptly.


Friday, October 30, 2015

#RingWorm skin infection common in #BJJ, #wrestlers and other contact sports.

Ringworm is not really a worm infection at all, it is a form of tinea or fungal infection of the skin.
The infection looks like a ring in nature hence the name, can be raised at the borders.   I have heard of athletes using cigarettes the burn the ringworm out.   Old folkstale cure in the BJJ world possibly but the cigarette burn damages the layer of skin where this fungus lives. In essence killing the fungus as well as its food supply.   Analogy of bulldozing  a house for a roach infestation.     There are safer, less damaging  though less macho ways to treat this infection.


Warm, moist environment such as wet shoes, wet uniforms, wet gym floors / mats from some hard core training can be the culprit, some quick facts


  1. can be passed from person to person
  2. can be easily treated, usually with topical , over the counter antifungals used for athlete's feet
    1. same organism
  3. rotate uniforms , shoes, socks so that they have enough time to dry between workouts
  4. if over the counter topical care does not resolve the issue, then call your doctor to be assessed and possible oral antifungals may be required or just a stronger cream that is only available via prescription from your doctor

How to avoid
  1. rotate shoes , socks and uniforms
  2. fully dry your socks, shoes and uniforms prior to wearing.
  3. Use a rashguard, my favorite is 

Monday, October 26, 2015

#MRSA aka Methicillin resistant staph aureus infection in #BJJ, #Wrestling + other contact sports, what you want to know

MRSA aka methicillin resistant staph aureus infections are more common nowadays due to previous over use of antibiotics and nature of bacterias to quickly mutate their genes to resist certain antibiotics.    Staph is all over our skin and a natural part of our skin flora or home bacteria, but if there is a cut / rash, the bacteria can enter the body and cause an infection.    If an abscess forms a surgeon would have to perform surgery to drain the abscess and take a culture to assess the bacteria and sensitivity to antibiotics.   Majority of skin infections are still regular staph or MSSA methicillin sensitive, but if high suspicion or history of MRSA then the patient is usually started on one of the anti MRSA drugs vs normal antibiotics.


  • Risk factors:
    • Previous history of MRSA infection
    • Immunocompromised patients such as: HIV, Rheumatoid pts on immunosuppressants
    • Increase number of people on the mats over time vs interval of cleaning of the mats with antiMRSA agents.   
    • Rolling / training that results in skin abrasions often = more probability for catching and spreading infection. 
    • Healthcare workers, corrections officers etc can be carriers of MRSA on their skin and in their nose due to hazards of the job. 
      • often we, the doctor, assume MRSA until proven otherwise in this group. 
  • Signs of MRSA infection:
    • Redness, pain at the site
    • Regular antibiotics does not work
    • increase in size of redness and swelling
    • increase drainage from the site despite antibiotics
  • What to DO:
    • Go to urgent care or physician ASAP 
    • If initial antibiotics are not working please return to the urgent care or physician ASAP
    • Must have history of previous antibiotics taken for this particular infection as well as other skin infections in the past
    • If after hours , report to nearest emergency room, some of these MRSA can spread fast causing significant tissue injury.   Injured tissue area  great source of food supply for the MRSA  bacteria. 
  • Oral antibiotics vs IV antibiotics
    • There are some oral antibiotics that works well for MRSA infections. 
    • If usual antibiotics don't work a quick workup with a culture or sample of the wound is required to help identify which antibiotic your infection is more sensitive to. Every bug is different in the way it responds to antibiotics
  • How to lower your chances
    • Clean gym on a regular basis
    • Clean uniform required for classes
    • Rash Guard with Silver as a part of fabric such the Hyabusa silver rash guards which are my favorites. 
      • Silver is a nature antimicrobial and rashguards and prevent rashes and cuts.


Monday, October 12, 2015

Giants player, Daniel Fells infected with MRSA stemming from a a foot & ankle injury

Giants player, Daniel Fells infected with MRSA stemming from a a foot & ankle injury. What is MRSA? 

MRSA stands for Methicillin Resistant Staph Aureus, this is a form of staph aureus that is resistant to most common antibiotics such as penicillins, etc.   In general, bacterias become resistant from exposure to antibiotics in the past or they can obtain a gene through a virus or another bacteria that renders them untouchable by an antibiotic class.  MRSA used to be an uncommon strain during my medical and surgical training with vancomycin IV being the drug of choice.     

Two common subgroups: Hospital acquired or community acquired. 

Treatments for such:


  • IV antibiotics like vancomcyin
  • Orals such as tetracycline class, bactrim, zyvox, etc. 
  • Surgical debridement
  • removal of infected tissue and flushing out of infected tissue. 
Identification:
  • Done through a culture of the bone, tissue, wound, drainage by your physician
Ways to avoid and treat
  • contact sports
    • wear rashguards with silver such as hyabusa silver lined rash guards
    • wash all wounds with warm water and antibacteria soap
    • redness or swelling, see a doctor ASAP
      • if on antibiotics and still redness and pain persists see your doctor again or go to urgent care or emergency room
Results if left untreated
  • Deep space infections requiring significant surgery
  • removal of significant tissue, even amputation by a surgeon
  • death in cases whereby the bacteria enters the blood stream

Dr. Kevin Lam
www.NaplesPodiatrist.com


Thursday, October 1, 2015

Foot and ankle #fractures hard to find at times after accident

#Injuries such as #slipandfalls #motorvehicle #mva  may not result in the typical mechanism of injury that we study in school in trauma classes.  The pattern of injury can be just plain crushed or twisted or retwisted (if there is such a term) in various ways vs a typical mechanism or trajectory.    The foot contains 28 bones and a good portion of them are flat bones which means they will be hard to examine via a plain film which is 2 dimensional in nature.   CT or MRI is often requested after a severe injury with unknown or difficult mechanism of injury.     At our center in #Naples, FL when encountering such trauma, an xray is initially taken, if the pain level of the patient does not correlate with the xray findings an MRI, CT would get ordered to exam the bones and ligaments in more detail.  Often injuries are missed or delayed in care without the proper imaging and suspicions. CT's are better for bone injuries while MRI's are more comprehensive and used more for soft tissue , tendon, ligament injuries.   

When injured in #MVA, #workerscompensation injuries, always tell your doctor everything that you remember.  Detail is important in figuring out the injuries that may affect you for life.    This history will also help when multiple specialists are required to be involved in your care. 

Seek immediate medical attention. 

Tuesday, September 29, 2015

Foot & Ankle Fellowship Program #SWFL first

Family Foot and Leg Center has been approached many times about doing a training program, namely a residency program for podiatric surgeons.  Due to the lack of time to train fresh graduates from podiatry school, we have agreed to start a post graduate fellowship instead in reconstructive rearfoot / ankle surgery.  Due to the vast variety of cases and complexity seen at the Family Foot and Leg Center, PA  we have are able to offer excellent training to post residency candidates with at least 3 years of post surgical training after their DPM graduation.

Benefits:

  • 1 year program 
  • Extended OR experience that is hands on w double board certified surgeons and fellows of the american college of foot and ankle surgery. 



Requirements:

  • 3 years or more surgical residency
  • Letter of Recommendation from Residency Director
  • MD , DO or DPM  degree
  • School transcript
  • If DPM must pass the ABFAS  foot and rearfoot / ankle written test part I
  • FL state licensure or able to do such
  • DEA active



                   

Monday, September 21, 2015

Kelly Ripa and Husband with foot injuries

Celebrity Foot Focus

Talk show host Kelly Ripa and husband actor Mark Consuelos each injured their left foot within a few days of each other. Although she broke her foot in a dance class by landing on a hand weight, and he during a workout

Celebrity Foot Focus

Talk show host Kelly Ripa and husband actor Mark Consuelos each injured their left foot within a few days of each other. Although she broke her foot in a dance class by landing on a hand weight, and he during a workout, they are wearing matching medical boots while healing.t, they are wearing matching medical boots while healing.

Friday, September 18, 2015

Talus fracture : Personal Injuries #PI common in motor vehicle accidents #MVA

Injuries to the foot and ankle sustained during a motor vehicle event of car vs car or car vs human is very common.  Common one to be explored here today is the talus.

Talus aka Astralgus aka Aviator's injury / fractures were first explored in airplane injuries due to the rudder controls on the plane.   A rough landing or crash would have the foot forcefully dorsiflexed or foot towards ankle injury that causes either a contusion, stress fracture or even a talar neck fracture as below.  This motion or mechanism of injury is similar to when a person's foot is on the brakes of a car in an attempt to stop or reduce a collision.



Below is after repair with opposing screws. 

Often, the foot / ankle is neglected after a motor vehicle accident as the injured is often dealing with other pains such as the neck and back etc.    Always get the foot and ankle assessed after a #MVA as the patient above walked on her broken foot for 1.5 months before seeing me.   Miraculously, she healed without any complications despite delayed surgery.



Dr. Kevin K. Lam
Comprehensive Foot & Ankle Care
Post Residency Reconstructive Rearfoot / Ankle Surgery : Fellowship Director
www.NaplesPodiatrist.com
Office: 239 430 FOOT
Fax: 239 692 9436
Blog:  www.DrKevinLam.com
Double Board Certified Podiatric Surgeon

  • American Board Of Podiatric Surgery
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery
  • American Board of Lower Extremity Surgeons
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery


#Oprah still has #Bunions

Oprah Still Has Bunions!!!


We all know that America’s favorite queen of talk has the infamous bunions on her feet. Back then, Oprah talked about bunions with her in-house medical expert Dr. Mehmet Oz during her show. Dr. Oz advised that initially, the #bunions should be managed conservatively. Among the conventional ways to manage bunion is by taking anti-inflammatory drugs such as ibuprofen to relieve pain and swelling. Foot inserts are also recommended to help position the feet to minimize abnormal foot movement, helping to prevent the bunions from getting worse. But ultimately, surgery is the only way to truly treat or remove a bunion. Recovery time could take about 6 months.
That was back in 2011 and Oprah still hasn’t got her bunions fixed. This may be because of her busy schedule or because of Dr. Oz’s advice not to go through bunionectomy. But although there are some cases of bunion surgery gone wrong, it not fair to generalize. The success of bunion surgery relies on the extent of the bunion, the technique, and most particularly the skill of the surgeon.
Fortunately, thanks to improvements with surgery, patients no longer have to experience painful post operative bunion surgery due to the outdated and very invasive bunioninectomy procedures that may still be being done. Minimally invasive bunion surgery is the latest surgical technique to address ugly and painful bunions.
Minimally invasive bunion surgery only requires a very small incision, in fact, only about 5mm. This is to gain access to metatarsal bone. Now depending on the severity of the bunion, the surgeon decides where to cut the metatarsal bone. Once the bone is cut, the metatarsophalangeal joint and big toe can be freely manipulated, this allows the surgeon to align the joint and big toe and once aligned, they are pinned in place and that’s it. This procedure is very simple and hence, very minimal pain and swelling after the surgery and during recovery. Some patients can walk a day after surgery with the aid of a special boot, others can drive on day 5 even with the pin inserted. Minimally invasive bunion surgery: very simple procedure, minimal pain, minimal swelling, gets patients on their feet sooner. So what do you say? A day or two of bed rest and back to work, work, work.


She has to come to Naples, FL in #SWFL to get them fix via the Minimally invasive method
What do you think? 





Wednesday, September 16, 2015

Secrets to Picking a Foot & Ankle Surgeon

Podiatrists and Orthopedist both can do foot and ankle surgery.  How do you pick the best one for your needs?

Both Podiatrists and Orthopedists go through 4 years of graduate school didactic training.


Orthopedists that are fellowship trained in foot and ankle surgery has an extra 6 months to 1 year training in foot / ankle surgeries after their general orthopedic residency.

Podiatrists go through residency then most decided to go further to a foot and ankle fellowship for 1 year after that to gain further experience in the area they are most interested in such as: sports medicine, diabetic limb salvage, reconstructive surgery of the foot and ankle.



  • Don't shop by initials: MD, DO, vs DPM.   If someone says I'm and MD you should trust me more than a DO, DPM, etc. that is a sign of all they have going for them.  Believe me, I have heard patients who have sought second opinions and returned with this self serving comment. 
  • Results and experience are what matters
    • Who does the most of these surgeries at the hospitals
    • You would be surprised that some doctors only do bunions and hammertoes but will dabble in ankle surgery
    • Some will do hip and other traumas then try to do foot / ankle surgery because it is a bone. 
  • Board Certification by the American Board of Foot / Ankle Surgery for Podiatrists
    • Did you know that there are two parts to the American Board of Foot / ankle surgery? 
    • Majority of podiatrists are certified in only foot surgery
    • only about 900 + in the USA are Certified in Rearfoot / Ankle Surgery
  • Board Certification by the American Board of Orthopedic Surgery for Orthopedics

Dr. Kevin K. Lam
Comprehensive Foot & Ankle Care
Post Residency Reconstructive Rearfoot / Ankle Surgery : Fellowship Director
www.NaplesPodiatrist.com
Office: 239 430 FOOT
Fax: 239 692 9436
Blog:  www.DrKevinLam.com
Double Board Certified Podiatric Surgeon
  • American Board Of Podiatric Surgery
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery
  • American Board of Lower Extremity Surgeons
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery

Monday, September 14, 2015

Quick Guide to Bunion Surgery- Don't get bunion surgery without reading this

Quick Guide to Bunion Surgery
  • Bunions can dislocate when they get severe enough
  • Bunion surgery does not have to be painful, improved surgical techniques such as our minimally invasive procedure  / scarless bunionectomy decreases pain to almost nothing
  • Bunions can cause arthritis to set in
  • Numerous procedures, ask 10 surgeons and you can get up to 10 different answers on how to address
  • Can be done in the office setting saving money, time, and risk of hospital acquired infections
  • Choose a doctor that has the most experience, not initials after their name, MD, DO, DPM, etc. 
  • Family Foot and Leg Center, PA does average of 10 bunion surgeries a week or more. 
Below you will see a bunion and bunionette (tailor's bunion) corrected in 18 minutes via the scarless method

Tuesday, August 25, 2015

A complete guide to neuromas: what your doctor may not know: must see video




#Neuromas are inflammation of the nerve in between the metatarsals.
Symptoms:

  • Burning at the bottom of the foot near the toes
  • Feeling of a rolled up sock in the toe space
  • Numbness between the 2nd and 3rd,  or 3rd and 4th   or 2nd to the 4th


Treatments

  • Steroid injection
  • 4% alcohol and / or sarapin injections to deaden the nerve
  • physical therapy: nerve stimulation / ultrasound / range of motion
  • metatarsal cookies / padding
  • Shockwave therapy
  • Radiofrequency ablation (burning of nerve)
  • platelet rich plasma
  • stem cell injection
  • Surgery to remove nerve 
    • NOT recommended as first line of treatment, with complication rates up and above 50%, can be worse than the neuroma pain initially. 
    • Stump neuromas or total regrowth can happen with more pain and now scar tissue

What you want to know about : Stem Cell the ultimate transformer cell

When we are conceived and developing we start with one common cell that then divides and so forth. How did we get all our various structures that makes up the human body from that one cell?   Stem cells is one short answer.  The stem cell is a pluripotent or capable to be made into various kinds of cells / building blocks.  The initial cells will get a signal to differentiate into the blood vessels, heart, brain cells, muscle, etc.    

This is in a nutshell how stem cells work.    When we inject into a joint the cells will differentiate into cartilage and capsular cells, or when we inject into a tendon the cells will form tendon cells.

We have been able to fix achilles tendon ruptures or partial tears with stem cells alone without surgery, in fact, I have not have to do achilles tendon repairs in ages due to stem cells.

Joint pain relieved from 50% to 100% with one stem cell injection. MRI studies show that at 6 months new mature cartilage is noted.  Personally,  I had a lateral meniscus tear that resolved after my stem cell injection confirmed with pre MRI and an MRI 1 year after.


Where do the stem cells come from?   The stem cells that we use are from and FDA approved tissue bank that harvest amniotic tissue from healthy females after a live birth. The chorion layer is removed and pure amnion is harvested and frozen at -80 C to place the cells in animate suspension until ready to use, remember the sea monkeys?

Amniotic stem cells are consistent and hypoallergenic, contains hyaluronic acid intrinsically and will immediately start to relieve joint pain and stiffness.  Best results are seen at about six weeks after injection.  An ultrasound is used to guide in the injection ensure 100% placement into the target joint or tissue.

This is what I use for myself, my family and friends who want regenerative technology to stay active.





Stem Cell for Knees

Tuesday, August 4, 2015

HyProCure® Before & After TaloTarsal Stabilization





Adult and pediatric flat foot deformity is often overlooked by physicians.   Often I hear, "my pediatrician says my child will grow out of it, etc."  
Reality is that if uncontrolled, more severe deformities can result such as tendon collapse, tendon tears, hips, knee and back pain.

A lot can be done nowadays for patients from simple implants such as the +HyProCure®  implant to bone grafts and fusion.  Not all doctors are familiar with these surgical options.    Seek one with experience in dealing with pediatric and adult flat foot deformities to get a full picture of your options.

Friday, July 31, 2015

Flat foot and bunion repair 3 stitches



Flat feet can be asymptomatic or in this case very symptomatic with pain and instability of not only the ankle but also of the foot joints.

Bunions can be caused by flat feet with every step you take the big toe moves more towards the midline of the body causing this bunion. It is not a coincidence that people with horrible bunions also have a flat foot deformity.      Here, I match a  minimally invasive flat foot procedure with a minimally invasive bunion that I have modified to give awesome results with the typical downtime and complications associated with traditional flat foot / bunion procedures.

Flat foot deformity can cause hip, knees and back pain in kids and adults.
Kids will not grow out of a flat foot deformity, it must supported at the least.     For those that are painful beyond simple orthotics or inserts control, surgery may be required.


 visit www.ScarlessBunion.com for more information about my scarless bunion procedure.

Monday, June 15, 2015

Neuromas by Naplespodiatrist.com

Tarsal tunnel injection under ultrasound







Tarsal tunnel syndrome symptoms:

  • burning inside the ankle
  • burning bottom of the foot
  • tingling bottom of the foot while standing
Treatment
  • therapy
  • corticosteroid injection
  • surgical release if all else fails
Here in this video it shows how the  posterior tibial nerve within the tarsal tunnel is located and injected with corticosteroid to help a patient with the above symptoms. 


Tale of two bunionectomies

Dr. Lam discusses neuropathy

Tuesday, May 5, 2015

Britney Spears Sprains Ankle in Vegas show: OOPS she did it.

Britney Spears Sprained Her Ankle, Fall during Show

#britneyspears

Britney Spears was in the middle of her show at Planet Hollywood in Las Vegas when she sprained her ankle. The pop star was performing her hit song “Crazy” when she twisted her ankle and fell (see image). Surprisingly, she handled it very well and finished the song. She was later advised by her physicians to postpone her succeeding shows for her sprain to heal.




Now wearing a boot, shared on her Instagram:


What is a Sprain?
A sprain is the stretching or tearing of a ligament. A ligament is a fibrous tissue that connects bones, cartilages or hold joints together.

What causes a Sprain?
There are a lot of causes of sprains. Falling, twisting, or any force that can violently place a joint out of its normal position, causing the ligaments to stretch and tear that may lead to a foot sprain.
Signs and symptoms of sprains include pain, swelling and bruising of the affected joint.
Treatment includes:
  1. Immobilization and resting of the injured joint. Your physical therapist may require you to use a special boots and crutches.
  2. Apply ice for the pain and swelling. You maybe advised to ice the affected area for 20 minutes for around 4 to 6 times a day.
  3. Elevating the foot above your heart can prevent pooling of bodily fluids to the foot and can drastically help reduce swelling and pain.

Dr. Kevin K. Lam
Comprehensive Foot & Ankle Care
Post Residency Reconstructive Rearfoot / Ankle Surgery : Fellowship Director
www.NaplesPodiatrist.com
Office: 239 430 FOOT
Fax: 239 692 9436
Blog:  www.DrKevinLam.com
Double Board Certified Podiatric Surgeon
  • American Board Of Podiatric Surgery
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery
  • American Board of Lower Extremity Surgeons
    • Foot Surgery
    • Reconstructive RearFoot & Ankle Surgery





Friday, April 17, 2015

Amniotic Stem Cell Treatment and Knee Arthritis


Dr. Kevin Lam of Naples, FL offers alternative to surgery for knee  arthritis


Arthritis is a general term used to signify inflammation of one or more joints. Typical symptoms include pain, swelling, and stiffness of the affected joint. Arthritis can affect any joint in the body but is notably common in the knee.
Knee arthritis can affect a person lifestyle. The pain associated with knee arthritis makes daily activities difficult, like walking or climbing the stairs. There are many types of arthritis that can affect the knee such as rheumatoid arthritis and post traumatic arthritis, but osteoarthritis is the most common especially among the elderly.
Osteoarthritis of the knee or degenerative osteoarthritis is a condition where the natural smooth lining of the joints which is the cartilage starts to thin out and wears away. This cartilage is very smooth and slippery and it also acts as a shock absorber. Unfortunately, as we age, this joint is susceptible to wear and tear, therefore, thinning the cartilage and exposing the rough bone underneath, which can cause severe debilitating knee pain.
Treatment
Treatments of osteoarthritis affecting the knee focus on controlling joint pain and preventing further damage to the joint. This involves lifestyle modifications such as losing weight, minimizing strenuous activities, dieting, taking medications (pain relievers, steroids) , physical therapy and other remedies. But in worse cases when the pain can no longer be alleviated by conservative means, surgery is recommended like total or partial knee replacement.
Knee replacement involves removing the damage knee and replacing it with metal plates. Unfortunately, the procedure does not guarantee alignment and stability and may require repeat surgery to accommodate this. Also, several complications could occur:
  1. Knee stiffness.
  2. Wound infection.
  3. Infection of the replaced joint.
  4. Rejection of the prosthetic joint.
  5. Nerve, tendon, ligament or artery damage.
  6. Deep vein thrombosis.
  7. Persistent pain at the knee.
Amniotic Stem Cell Treatment for Knee Osteoarthritis
Stem cells are unique cells that are capable of changing into different cells. When stem cells are injected into a damaged joint, the cells transform into specialized cells, in this case chondrocytes to produce new cartilage. Also, these cells accelerate the body’s own repair system; hence, decreasing inflammation, promote healing, prevent scaring and improve joint function.
Other advantages include:
  1. Amniotic stem cells contain cytokines. Cytokines are signaling molecules that boost the communication of immune response cells and stimulate the migration of these cells toward sites of infection, trauma and inflammation.
  2. Amniotic stem cells also contain hyaluronic acid. Hyaluronic acid is a substance naturally found in the human body and like cytokine, hyaluronic acid cures injured tissues faster and promotes bone growth and regeneration of cartilage tissues.
  3. Amniotic stem cells do not cause patient rejection and allergic reaction.


www.topstemcell.com




Advantages of Using Stem Cells versus Steroids in Treating Foot and Ankle Pain


Stem cells are special biological cells that have the ability to differentiate to other types of cells and repair or regenerate damaged cells in the body. Due to medical advancement, we can now use the regenerative characteristics of these cells to treat an array of medical conditions, including foot and ankle pathology.

Amniotic stem cells are commonly used in regenerative medicine as it does not cause any moral or ethical issues. These amazing stem cells are considered to be undifferentiated cells, which mean they have the ability to change to different kinds of cells like skin, bone, blood and liver cells. When amniotic stem cells are injected to the affected area, these cells can repair and regenerate the surrounding tissues, able to control pain and swelling, and treat previously incurable conditions. This medical breakthrough is said to be the future of medicine.
Advantages of amniotic stem cell therapy:
  1. Amniotic stem cells have the ability to stimulate new tissue growth and repair.
  2. The cells contain natural occurring anti-inflammatory agents like cytokines to control pain and swelling.
  3. Amniotic stem cells can help promote bone and cartilage regeneration, and could help lubricate the joints because it contains hyaluronic acid.
  4. Amniotic stem cells will not induce an immunologic rejection response, patient rejection is extremely rare.
  5. Amniotic stem injections are preferred compared to other sources of stem cells like embryonic stem cells or stem cells extracted from the patient’s own blood because amniotic fluid is a highly concentrated source of stem cells.
  6. Amniotic stem cell also contain hylauronic acid which is the building block for cartilage and healthy joint fluid. 

How are these harvest? 

Amniotic stem cell donors are prescreened and processed through an FDA approved tissue bank. 
The lab then harvest  the live cells, process them and freeze them in -70C for cryopreservation prior to usage.    Our office obtains the cryopreserved stem cells and place them in our ultra low temp freezer until ready for usage. 


Is it safe?
100% safe. 

Insurance cover? 
No, insurance, medicare does not cover these regenerative treatments. Pro athletes and the elite has used this technology for some time, now made available to the masses? 

Do I qualify?
You must be evaluated by our physicians first. If you are a candidate some procedures can be done the same day or scheduled within 24 hours.  
We have consultant physicians on staff that will do injections above the hip joint for instance, tennis elbow, arthritic thumb, etc. 

Repair naturally, not replace or cover up. 

NOT all amniotic stem cells are the same. 
The pure amniotic stem cell does not involve the chorion layer of the amniotic sac.   This chorion layer has been known to cause inflammation and host reactions.   Company's that offer this cut costs by decreasing the processing and using chorion as a filler material. 
We have had patients that had other amniotic tissue injections to no avail. I prefer to use live stem cells and purest form possible for my patients.    Analogy would be using live bait for fishing or dead cut bait.  If you had the choice which would you choose? 

Comparison to Steroids

Steroids injections provide excellent pain and inflammation control and are generally safe. Unfortunately, there are still potential side effects and disadvantages, especially after chronic use.
  1. Temporary relief. Just like other medication, pain and inflammation control provided by steroid use is limited and a repeat injections maybe needed for continued relief.
  2. Post injection pain. For some patients, steroid injections can be very painful and may require anesthetic injection.
  3. Anaphylactic reaction. An allergic reaction or worse, an anaphylactic shock is probably the most dangerous side effect after joint injection of steroids. This is a life-threatening medical emergency and an experienced medical practitioner should identify the early signs of allergic reaction.
  4. Skin changes. For some patients, skin discoloration and atrophy could occur on the injection site, especially with patients who have darker skin.
  5. Risk of elevated blood sugar among diabetics. Diabetic patients who undergo steroid treatment should monitor their blood sugar levels.

Dr. Kevin Lam and FFLC offers
Full line of PRP treatments and Amniotic Stem Cell treatments in office.

Friday, February 6, 2015

Naomi Campbell’s Bunions

Naomi Campbell’s Bunions

One of the most recognizable models of the 90s is Naomi Campbell. The English model is also an actress, singer, and author. Having been modeling since the age of seven, she quickly became famous internationally. Even after the end of the supermodel era in 1998, she still continued print modeling.
Having a modeling and acting career means having to constantly wear high pointy shoes. Although there is some uncertainty over the exact cause of bunions, wearing high heels and narrow-toed shoes has always been one of the possible reasons, along with heredity, staying on your feet for prolonged periods, pre-existing foot conditions, and arthritis.

Due to the harm that some models do to their feet, walking and standing for hours in stilettos, some not even the right size, many struggle with hammertoes, plantar fasciitis, Achilles tendinitis, and yes – bunions. Naomi Campbell is no exception.

The worst pair of shoes a woman can wear are pointy ones because these crunch the toes. Combine this with high heels and the result is that the weight of the body gets forced on the toes, resulting in knobby toes, unattractive clawed toes, and bunions. Later on, these foot problems can affect walking and foot pain can become debilitating.

To minimize the odds of getting bunions, never force your feet into shoes that do not fit well. If you already have a bunion, relieve pressure by wearing shoes with enough room. Protective pads may also be worn.


If pain has become unbearable, then you may need surgery. Minimally invasive bunion surgery is a 5mm minimal incision bunionectomy, minimal discomfort, and virtually painless. There is no need to fear the bunion treatment due to pain or scarring. This revolutionary procedure is here and refined at the Family Foot and Leg Center, PA by Dr. Kevin Lam. Call (239) 430-3668 for more information or visit www.scarlessbunion.com

Tuesday, January 27, 2015

Diabetes Deadlier than Cancer

iabetic Foot Disease Has Higher Death Rate than Most Cancers

Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death, and a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death1. One of the common contributing causes of death in diabetes is a diabetic foot ulcer (DFU), and if left untreated could lead to lower extremity amputation (LEA). Five-year mortality rates after new-onset diabetic ulceration have been reported between 43% and 55% and up to 74% for patients with lower-extremity amputation2. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin's disease.


Approximately 15% of all diabetic patients will get a foot ulcer in their life3. Foot ulcers occur due to lack of sensation to the foot. Peripheral neuropathy, another condition commonly found in diabetics, damages the nerves, impairing sensation to the foot. This allows injuries to go unnoticed, leading to infections and ulceration. Diabetic foot ulcers are extremely difficult to treat, and it would take months for the wound to heal and incidence of reoccurrence is high. In the U.S., approximately 67% of all lower extremity amputations occur in diabetics, and approximately 85% are preceded by a foot ulcer4.

What to do?

The key in stopping diabetic foot ulcers and possible amputations is to practice proper foot care and to control diabetes.

Foot care regimen:
  1. Wash feet regularly. Use a mild antibacterial soap and towel dry.
  2. Keep foot dry. Use antiperspirant powder when wearing shoes to keep your feet dry. Excess moisture can soften the skin, making it vulnerable to skin breaks and infections.
  3. Moisturize. A foot that is too dry is susceptible to skin cracks, moisturize with your favorite lotion.
  4. Cut nails carefully.

Daily Foot inspections:
  1. Look for cracks or scratches and treat immediately with an antibiotic ointment.
  2. Check for sensation on your foot. If there is decreased sensation than usual, immediately visit your doctor.
  3. From time to time, inspect the insides of your shoes if there is a pebble or anything protruding that could injure your foot.

Control Diabetes:
  1. Take medications regularly.
  2. Go on a diet. Control food consumption to prevent increase in blood sugar levels.
  3. Do not miss your doctor’s appointments/check-ups.


1 http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav#sthash.k3SPUfEL.dpuf

2 “Mortality Rates and Diabetic Foot Ulcers” in Journal of the American Podiatric Medical Association, Vol 98, No 6, November/December 2008

3 National Diabetes Data Group: Diabetes in America, Vol. 2. Bethesda, MD, National Institutes of Health 1995 (NIH publ. no. 95-1468)


4 Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 1990;13:513--21.

Monday, January 26, 2015

Michelle Yeoh with bad bunions

Michelle Yeoh’s #Bunions and  #Corns


I remember as a child watching Michelle Yeoh doing kung fu movies along side Jackie Chan, etc. She needs a minimally invasive bunionectomy bad before she gets major arthritis in her big toe joint then forget the high heel after a fusion.  Fusion is when the big toe joint or any joint for that matter is locked via plates and screws by a surgeon to limit motion, restore anatomy as well as remove diseased tissue.  

Malaysian-born Chinese actress Michelle Yeoh, popularly known for performing her own stunts in the Hong Kong action films, caused a stir when she was seen with her heavily corned feet at an appearance. Chosen as among the 50 Most Beautiful People in the World in 1997, the Crouching Tiger, Hidden Dragon star is gorgeous, but her feet are another issue, especially those bunions.
Feet constantly stuffed in very tight stilettos may look stylish but can be unforgiving to the toes. Women do love their high heels but wearing them all the time may lead to foot problems and foot pain. The foot conditions associated with these towering shoes include corns, calluses, hammertoes, and the most commonly seen bunion. The condition often gets worse over time but surprisingly, almost half of women admit to wearing a pair of shoes that they liked even if it gave them discomfort.


Michelle Yeoh,as a fan and a foot and ankle surgeon, give my office a call about the minimally invasive bunionectomy:    239 430 3668. 


Monday, January 19, 2015

LeVert Possible Repeat Stress Fracture Injury

LeVert Possible Repeat Stress Fracture Injury


Michigan’s shooting guard Caris LeVert will be sitting it out for the rest of the season due to a foot injury. LeVert was limping after a victorious game against the Northwesterns Wildcats and later that night he was seen on crutches. He is scheduled for surgery this week, following a 12-week and rehabilitation period.


LeVert injured the same foot he had surgery on last May due to a stress fracture, and most likely, he may have the same injury since the recurrence of stress fractures are very high.  

What is a stress fracture?
Stress fractures are small but painful cracks on the bone, usually affecting the foot. This occurs because of muscle fatigue, the over used muscle can no longer absorb shock, thus transferring all the stress to the bone, leading to tiny cracks. Stress fracture is one the most common injuries in sports.   I always refer this to thinking about an egg shell with cracks but not fully broken so that the content does not spill out.    MRI's are excellent at diagnosis this condition, but the advent of ultrasound provides a quick and more cost effective alternative. 
Some patients may have pathological fractures: eg bone tumors or osteoporosis, this needs to be checked thoroughly by a physician. 


Treatment

Rest is the best treatment for stress fractures. Allow the injured bone to heal for 6 to 8 weeks, the patient should not engage in with the activity that caused the fracture during this period. Recurrence of stress fracture is common, which causes larger cracks  or a full fracture that can move out of place and that takes longer to heal and lead to possible surgery.

Another treatment available is injection of stem cells or amniotic stem cells to the fracture site to aid the body in healing of this condition.  This is not covered by insurance but has been proven to cut the healing time in half in fusion cases whereby the surgeon creates a fracture on purpose to allow two bones to mend together.  Fusions are done for generative joint disease and severe deformities such as a collapsed foot or multiple fractures that require stabilization. 


If you have a nonhealing stress fracture or repeat stress fractures see your doctor. 

Thursday, January 15, 2015

Courtney Love have Plantar Fascitis?

Plantar fascitis remains one of the most common problems seen in our practice. in the picture below is   Courtney Love wearing a posterior night splint that is usually one at night to help stretch out the Achilles tendon and the plantar fascia.  This is part of the treatment protocol for plantar fasciitis at our office. Most of the time people will complain about pain upon first steps in the morning that is because the plantar fascia , a ligament on the bottom of the foot that attaches to the heel, is inflamed as well as contracted during the night of sleep. This is why the plantar fascial night splint is very important to use at night when you have an attack of plantar fasciitis. We do not recommend walking on your plantar fascial night splint however for it is not meant to be a weight bearing apparatus  The most common treatment for plantar fasciitis is an injection of corticosteroid, or injection of PRP, or the newest injection is amniotic stem cell injection into the  plantar fascia to allow for healing.  I cannot over emphasize the need for stretching at physical therapy as well as arch supports to help aid in the healing and prevention of future attacks of plantar fasciitis. This is a very painful and preventable problem. I am sure Courtney Love's podiatrist  would not have approved her walking on the beach with her night splint.



Wednesday, January 14, 2015

Victoria Beckham wearing corrective orthotics and reasonable shoes for her bunions.

Victoria Beckham and her Bunions
A bunion is a bony bump at the joint of the big toe. Over time, the bunions can progress and become more and more painful. It is estimated that around one in four people between the ages of 18 and 65 have bunions. Furthermore, the prevalence of bunions increases with age.
Victoria Beckham, for instance, has suffered from bunions for the longest time. She was probably predisposed to bunions from birth. Her misshapen feet have brought her years of agony. Constantly wearing those pointy high heeled shoes has contributed to its progression.



Because she did not want to ruin her stylish look, she puts up with the pain. She has previously voiced her dislike for flat shoes, saying “I beyond hate ballerina flats. I just don’t get it. I love heels.” She was so into heels that she even wore wedge sneakers when she was invited to pitch and open a Dodgers baseball game.


Thus, she has resorted to wearing corrective insoles in the hopes of avoiding bunion surgery. However, she has been advised to undergo bunion treatment soon, otherwise, it could lead to more serious foot problems.

Victoria Beckham faced bunion surgery to correct the painful condition. On one occasion, she was seen wearing a pain or manly brogues. This was quite a leap from the usual towering stilettos that Posh Spice often wore.

Bunion surgery does not have to be a painful experience. Newer techniques along with scarless bunionsurgery methods have allowed patients to start walking in a surgical boot much sooner. Bunionectomies have come a long way. Choose by reputation of the surgeon as their skills vary by their experience and training. 





Call for an appointment with Dr. Kevin Lam 239 430 3668 with the Family Foot and Leg Center, PA in Naples, FL.   




Monday, January 12, 2015

How to lose your feet to diabetes

Your feet and Diabetes
Diabetes mellitus or commonly referred to as diabetes is a lifelong condition that affects the body’s ability to absorbs sugars from food. Normally, the body breaks down carbohydrates from food and converts it to glucose, a simple sugar our cells use for energy. In order for our cells to absorb glucose, insulin is needed. Insulin is a hormone produced by the pancreases to control blood sugar levels in our body.
There are two types of diabetes mellitus. Type 1 is the loss of insulin producing cells in the pancreas and Type 2 is the lack of insulin production by the pancreas, which may be combined with the lack of response or resistance the cells and tissues to insulin.
Due to the lack glucose absorption in the body, there is an increase in blood sugar levels. High blood sugar levels can damage or obstruct small blood vessels all over the body resulting to renal problems, high blood pressure, heart disease, blindness and nerve damage.
Risk of Diabetic Foot
Since diabetes can cause obstruction to the small blood vessels, this can drastically decrease the blood flow and damage the nerve ending of the extremities especially the foot. The risk of having foot problems with diabetes are as follows:
  1. The patient has diabetes for a long time.
  2. The patient does not comply with the prescribed medications, leading to increased blood sugar levels.
  3. Lives a sedentary lifestyle
  4. The patient is smoker.
Lack of blood supply
Uncontrolled blood sugar levels can reduce blood circulation to the feet; making the patient prone to infections after any injury to the foot. Below are signs of poor blood supply to the feet.
  1. Cold feet.
  2. Wounds are slow to heal.
  3. Feet look pale or bluish in color.
  4. Frequent leg cramps after walking a short distance.
Nerve damage
Chronic diabetes can cause nerve damage due poor blood circulation. Symptoms of nerve damage are numbness or pins and needles sensation to the feet, while some patients feel a burning sensation in the legs during rest.
What to do?
  1. Take your diabetes medications regularly. Controlling your blood sugar levels is the key to preventing complications from diabetes.
  2. Stop smoking.
  3. Exercise. Regular activity will help improve blood circulation to your feet.
  4. Visit your podiatrist if you notice decrease sensation on your feet, if you have ulcers or cuts.
  5. Infections can quickly get out of control to blood infection and stays in the intensive care unit.

Diabetics are at high risk to impaired sensations, lack of blood flow, impaired nutritional status as well as impaired immune systems in most cases.   

See a podiatrist to save you limb and your life as 5 year survival rate after an amputation is grim. Diabetic complications have killed more people than cancer in the US. 
This it is a small problem still? 


Dr. Kevin Lam
www.NaplesPodiatrist.com