My Blog

By Dr. Robert J. Landy
February 02, 2015
Category: Podiatric Medicine
Tags: Prevention   frostbite   feet  

What Is Frostbite?

Frostbite is damage to the skin and other tissue after exposure to very cold conditions, usually below 0.55C or 31F.
Very cold weather makes 
blood vessels get smaller, affecting blood flow and the supply of oxygen.
Frostbite usually affects areas like the hands, 
feetears, nose and lips, but can affect any part of the body.
Symptoms of frostbite often start with 
pain from the cold, pins and needles and numbness.

Who is at risk of frostbite?

Those at a greater risk of getting frostbite include:

  • Those who take part in winter sports and high altitude sports, such mountaineers and skiers
  • People stranded in extreme cold weather conditions
  • People with jobs that mean they are outdoors in harsh conditions for a long period of time, such as soldiers, sailors and rescue workers
  • Homeless people
  • The very young and very old whose bodies are less able to regulate their body temperature
  • People with blood vessel damage or circulation problems, such as diabetes and Raynaud’s phenomenon
  • People taking medicines that constrict the blood vessels, including beta-blockers, and smokers.

Diagnosis of frostbite

A doctor will examine the affected areas and ask questions about how the parts of the body came to become frostbitten, and how long the exposure lasted.

The damage from frostbite may not be apparent soon after thawing and further checks dome days later may be needed.

Imaging scans, such as X-rays, bone scans or an MRI may be recommended to check for damage beneath the skin.

Long-term effects of frostbite

A person who's had frostbite may recover completely. However, some people may be left with increased sensitivity to cold, numbness, loss of touch and lastingpain in the frostbitten areas,

Frostbite self-care

  • First, call for help.
  • Keep the affected part elevated in order to reduce swelling.
  • Move to a warm area to prevent further heat loss.
  • Note that many people with frostbite may also be experiencing hypothermia. Saving their lives is more important than preserving a finger or foot.
  • Remove all constrictive jewellery and clothes because they may further block blood flow.
  • Give the person warm, non- alcoholic, non-caffeinated fluids to drink.
  • Never warm up an affected area if there is any chance that it may freeze again. This thaw-refreeze cycle is very harmful and leads to disastrous results.
  • Do not rub the frozen area with snow (or anything else, for that matter). The friction created by this technique will only cause further tissue damage.
  • Above all, keep in mind that the final amount of tissue destruction is proportional to the time it remains frozen, not to the absolute temperature to which it was exposed. Therefore, rapid transport to a hospital is very important.

Medical treatment for frostbite

  • After immediate threats to the patient's life are addressed, warming up is the highest priority.
  • The affected area should be re-warmed by immersing it in warm water.
  • Once the affected area has been thawed apply a dry, sterile bandage, placing cotton between any involved fingers or toes (to prevent rubbing).
  • Narcotic pain medications may be given because this process is very painful.
  • Because dehydration is very common, intravenous fluids may also be given.
  • After warming, post-thaw care is undertaken in order to prevent infection and a continuing lack of oxygen to the area.
  • Any clear blisters are removed, and the bloody ones are left intact so as not to disturb the underlying blood vessels.
  • tetanus booster is given if needed.
  • People with frostbite are admitted to hospital for as long as is necessary to determine the extent of injury and to receive appropriate treatment.
  • How can I prevent frostbite?

    Frostbite can result in serious consequences and prevention is extremely important. If you are planning outdoor activities, check weather forecasts frequently and heed warnings about cold temperatures and possible storms that might strand you in dangerous conditions. Avoid risky situations -- such as hikes or camping trips in cold weather -- that may be beyond your experience level. It is also wise to consult local park staff or other authorities about the weather, terrain, avalanche danger, and other conditions that may interfere with your ability to obtain shelter or emergency help.

    To prevent or reduce your risk of frostbite, dress properly in cold temperatures. This includes protecting your hands, feet, nose, and ears. Bundle in warm, layered, and loose-fitting clothes, a hat and scarf or ski mask, warm socks, and mittens (not gloves), and make sure 
    children are properly bundled. Go indoors periodically to warm up. Wet clothing or damp skin can increase your risk of frostbite.

  • If you've just arrived in a cold climate from a warmer one, give your body time to adjust before spending extended periods outside.
  • Avoid drinking alcohol before or during exposure to cold weather since alcohol may keep you from realising that your body is becoming too cold.
  • Avoid smoking cigarettes, which can decrease your circulation and increase your risk of frostbite.
  • At the first sign of redness, blueness or whiteness, or pain in your skin, which may indicate that you are becoming too cold or that frostbite is a potential risk, get out of the cold, warm up and protect the exposed skin.
 
By Dr. Robert J. Landy
January 27, 2015
Category: Noteworthy
Tags: Celebrity   Shoe   Shaquille O'Neal  

RE: Celebrity Shoe of the Day

 

Autographed Shaquille O'Neal's rookie shoe, size 20

 

Here's a picture Shaquille O'Neal's rookie shoe, size 20. It appears that his foot grew from his rookie year to an eventual size 23 at the end of his career. 

By Dr. Robert Landy
January 27, 2015
Category: Surgery
Tags: Hammertoe   Video   Absorbable Pin  

Traditional hammertoe surgery often results in metallic pins protruding out of the the patients toes. Most patients do not like pins protruding out of their toes. The protruding pins and have to be removed post-operatively. Patient do not like the idea of this either. The following technique leaves nothing penetrating the skin and nothing to remove. 

Click on the link below to see an animated video of the procedure:

Trim-IT Drill Pin: All-Inside Technique

If you would like to get more information on this procedure, request an appointment (below) or call the office:

Appointment Request

By Dr. Robert J. Landy
May 08, 2014
Category: Podiatric Medicine

The Centers for Disease Control have declared May as “Skin Cancer Awareness Month” and the New York State Podiatric Medical Association (NYSPMA), which represents more than 1,200 specialists across the Empire State, is urging New Yorkers to pay special attention to the skin on both the top and bottom of their feet.  Skin cancers of the feet are more often related to viruses, while harmful sunrays may be the primary cause of skin cancers on parts of the body that receive sun exposure. Doctors of Podiatric Medicine (DPMs) are foot specialists, trained to recognize and treat conditions that present on the skin of the foot. 

Oftentimes, skin on the feet, especially on the bottom, is overlooked during routine medical exams. Many times there’s a history of recurrent cracking, itching, bleeding or ulceration. These lesions can also be painless and may go undiagnosed until another issue presents itself near the affected site.

Checking for warning signs is something anyone can do, paying particular attention to changes such as non-healing sores, bumps that crack and bleed, nodules with rolled edges or scaly areas.  Examining the bottom of the foot is critical. 

Basal cell cancers may appear as pearly white bumps or oozy patches that can get crusty like other open sores.  On the foot, basal cell cancers often look like non-cancerous skin tumors or benign ulcers.

Squamous cell carcinoma is the most common type of skin cancer of the foot.  They usually are confined to the skin and do not spread.  However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer can begin as a small scaly bump, which may appear inflamed.  There can be cracking or bleeding.  Sometimes it begins as a hard projecting, callous-like lesion.  While painless, this type of skin cancer may be itchy.  It can resemble a plantar wart, a fungal infection, eczema, an ulcer or other common dermatological conditions.

Skin cancers on the lower extremity may have a different appearance that those arising on the rest of the body.  So to test, the podiatrist will perform a skin biopsy.  This is a simple procedure in which a small sample of the skin is obtained and sent to a lab where a skin pathologist examines the tissue in greater detail. If it turns out the lesion is skin cancer, the podiatrist will recommend the best course of treatment.

Each year, approximately 2 million Americans are diagnosed with non-melanoma skin cancers. Early detection and treatment of skin cancers often lead to a better prognosis. If you have a non-healing wound or a skin lesion that has grown in size or shape, has changed color, or has become more painful, see your podiatrist for an evaluation and/or a skin biopsy.

By Dr. Robert J. Landy
July 31, 2013
Category: Podiatric Medicine

New York, NY – July 31, 2013 - When members of the New York State Podiatric Medical Association (NYSPMA) were surveyed on whether they had ever discovered melanoma or skin cancer during a routine foot examination, 75% of the foot specialist respondents answered positively.

Survival rates are dramatically lower when melanoma is found on the foot since it often goes unnoticed until the patient is having a serious problem. If the melanoma is not caught in the early stages, the fatality rate is about 50% within five years of diagnosis.  All the more reason for checking your feet on a regular basis, say doctors of podiatric medicine.

“I’ve diagnosed melanoma through routine foot exams, said Dr. Robert A. Russo, President of the New York State Podiatric Medical Association and a practicing podiatrist.  “One example is a patient who came in thinking they had a plantar wart, but the biopsy I ordered proved it to be melanoma,” he added. 

 

Feet that are not regularly exposed to the sun during the year are very sensitive. Skin cancer can occur on the soles of the feet, as well as on the tops, between the toes and under the nails. Podiatrists say that it is important to have routine foot checks to diagnose any abnormalities that could be symptoms of the disease.

 

The majority of Americans have been conditioned to protect themselves by staying out of the sun or using a broad-spectrum sunscreen that blocks both UVA and UVB rays.  But many times feet, especially toes, are not given proper sunscreen protection.  Additionally, sunscreen must be reapplied regularly, especially after going in the water.

 

Signs of malignant melanoma – one of the most deadly forms of skin cancer - include changes to moles such as itchiness and bleeding. Also, normal lesions are generally one color, with a distinct border, and about the size of a pea or smaller and do not dramatically grow in size.  The A,B,Cs of possible melanoma lesions are:

 

A-Asymmetrical shape.

B-Bleeding or oozing.

C-Change in color.

D-Diameter of the lesion.  If it is large or getting larger.

E-Evolving. Changing in size, shape, border, color, itching.

F-Fingernail or toenail bruise that does not grow out with the nail.

For more information, or to find a doctor-member of the New York State Podiatric Medical Association in your area, visit www.nyspma.org and click on “Find a Podiatrist.”

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The New YorkStatePodiatric Medical Association is the largest statewide component of the American Podiatric Medical Association and its affiliated national network of certifying boards and professional colleges. Established in 1895, NYSPMA has over 1,200 members across 13 divisions in New YorkState. Visit www.nyspma.orgfor more information.  The Association is located at 1255 Fifth Avenue, New York, NY10029.

The information included in this article is for educational purposes only. It is neither professional medical advice nor is it intended or implied to be a substitute for professional medical advice. Without exception, the reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation, or if they have any questions regarding a medical condition or treatment plan. Reading the information in this article does not create a physician-patient relationship.





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