Are you Having Pain or Swelling in your Toes? Let's talk about it! w/ Jeffrey B. Klein, DPM

We have the honor of welcoming back one of favorite guests on this podcast episode of Head to Total, Dr. Jeffrey B. Klein. Dr. Klein and Colleen Young, our host, dive into the subject of ingrown toenails and how they become a problem if not taken care of properly. We will discuss some of the causes, proper toenail clipping etiquette, and who is most likely at risk and why. We hope you enjoy this episode and this fascinating topic as we continue to explore everything about your body from head to toe!

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Transcript

Colleen Young: Hi guys. Welcome to our next episode of Head to Total, the podcast that pulls back the curtain on all things medical. I'm Colleen Young and excited today because we have a repeat guest. Based on popular demand, we have invited back Dr. Jeffrey B. Klein, who is our well-known podiatrist with Mendelson Kornblum Orthopedics in southeast Michigan. Dr. Klein, thank you for coming back and talking with us.

Dr. Jeffrey B. Klein: Good morning. Thank you for having me. 

Colleen Young: Dr. Klein, we had so much in the last podcast that we're glad you're back because we went through my feet and the disaster that are my feet. And now we've come up with a lot of questions for you. So thanks again for coming back and taking time outta the busy schedule and stopping bunion surgeries on my feet to do this.

Dr. Jeffrey B. Klein: Thank you. And thank you for swearing never to wear shoes like you wore last time.

Colleen Young: Yeah, I lied to you Dr. Klein. I love you dearly, but I lied right to your face because the shoes I have on today, Dr. Klein, you can actually see the bumps. It’s not a pretty thing. But listen, enough about my feet and the agony that is my feet, a lot of people have asked me, you know, it's getting to be summer, southeast Michigan, we talked a lot last time about flip flops and sandals and foot care for all of that. But now friends of mine who have kids running outside in the yard and playing in the street, they're getting heel pain. I said well yeah, I'm not the person to ask, it’s Dr. Klein. And since I'm talking to him coming up, what's the deal Dr. Klein? What's going on with the kids and the heel pain? Is it plantar fasciitis? Is it heel spurs? What's going on?

Dr. Jeffrey B. Klein: Okay, usually children who have heel pain do not have plantar fasciitis or heel spurs, it's usually a condition that is called severs disease or it's osteochondritis. Basically what happens is as kids are growing, growth plates are open. When you look at an x-ray of a child, there are lots of joints, of course, in the foot and ankle, but there's also growth plates that are open that look like joints. As a child gets older, these growth plates will close as they stop growing. Girls are a little bit quicker than boys, you will not see the growth plates any longer on x-rays. For some reason, it seems to be mainly in boys, but girls can get a two, somewhere between the age of 8 and 12 years old, they can develop heel pain. It can start off with one heel and go to the next heel. Kids don't usually complain of pain, so it's a pretty severe and debilitating type of pain. It's usually common this time of year where people seem to walk around without shoes on or in flip flops or the shoes are getting smaller and they're not fitting as well. What happens is the growth plate on the bottom back of the heel, the apophysis is what we call it, gets inflamed and it gets very painful. The pull of the heel cord on one side is pulling at this growth plate on the back of the heel upward towards the knee. And the pull of the plantar fascia or the ligament on the bottom point is pulling in the opposite direction forward. And what happens is this growth plate becomes very painful. 

There are many different reasons that we theorize that cause this. Some people say it's a lack of blood flow to this growth plate. Not that they have poor circulation, but it's just not an area that has a lot of blood flow to it. Some pediatricians will call it growing pain. These types of problems can happen in many bones in the body, not only the heel. When I was younger, I had it on my knee and it's called Osgood Schlatter disease. But basically, what it is, it's a very painful condition and it requires rest. Rest means staying away from sports, and rest means wearing good supportive shoes. Sometimes we'll recommend a heel cup or something to control the biomechanics or the way the child walks. A lot of times we'll recommend anti-inflammatories, something like an ibuprofen, and a lot of times we'll recommend heel cord stretches that will actually take the tension off of this growth plate. Usually resting and staying out of sports for a week or so will usually get rid of it pretty quickly. A lot of times it is not going away rather quickly. And sometimes we'll put these children in a cast for a short period of time, and then after that we'll control the biomechanics or the way they walk with a pair of custom-made orthotics. And sometimes we'll actually send them to physical therapy where they work on various modalities to get rid of or to maintain this heal pain away period.

Colleen Young: So Dr. Klein, you said children ages 8 to 12, correct?

Dr. Jeffrey B. Klein: Yeah, it's most commonly seen in children 8 to 12 years old. When these patients come into the office, we’ll always take an x-ray to rule out other things like fractures or other conditions. But most of the time the diagnosis can be made just by history, where a sudden onset of pain in a child who's been exercising a lot more, playing a lot more sports, or wearing the wrong shoes or no shoes at all.

Colleen Young: Is it predominant in males versus females just because of growth spurts?

Dr. Jeffrey B. Klein: I think it is. I think that is the reason why, but I'm sure there are many theories of why it's more predominant in boys than girls. But it's a very common condition, especially this time of year.

Colleen Young: And you said about the growing pains and shoes not fitting well, transitioning from the back of the foot to the front of the foot, is that tight shoes and the rubbing, is that why people will get ingrown toenails as well?

Dr. Jeffrey B. Klein: Well that's one of the reasons that people get ingrown toenails. There are many reasons that people get ingrown toenails. One is improper-fitting shoes. I remember when my children were rather young, it seemed like I was at the shoe store every three weeks buying them new shoes as they seem to grow out of shoes rather quickly, and that's one cause. Another cause is hereditary factors. People who have ingrown toenails, a lot of times their parents and grandparents had them also. And another reason could be improper cutting of the toenails. Toenails should be cut straight across. When you talk about kids and toenails, a lot of kids will pick at their toenails. But as I was saying, toenails should be cut straight across. If they bother you or if they bother the person in the corners, then they can be filed into the corners or by coming into the office and they could be treated in many different ways to take care of the ingrown toenails.

Colleen Young: So does an ingrown toenail happen at the front of the toenail all the time? You indicated that it could happen on the side of the toenail too.

Dr. Jeffrey B. Klein: Yes, it is usually on the side of the toenails. If you look at your fingernails or your toenails, they’re semicircular or they're rounded off to the sides. And a lot of people who trim their toenails, they cannot see the corner of the toenails or the sides of the toenails, so they trim it out and they leave a little hook in the corner that they can't see. We call that bathroom surgery and we advise against that. And basically what happens is as the nail grows out, the hook or the corner of the toenail will grow into the flesh of the toe or the sides of the toe and cause a lot of pain. It causes irritation, inflammation, and of course can lead to an infection, and you wanna try and avoid the infection. But there are different treatments for the chronic recurrent or ingrown toenails that come back over and over again versus the ingrown toenail that just occurred once because they trimmed them improperly the one time.

Colleen Young: So go back for a start Dr Klein about the bathroom surgery. Because I think a lot of people try to do a lot of manicuring of their feet so that they don't have to come and see you and they don't have to show you their feet, which is absolutely ridiculous because one of the best things you do is go to a podiatrist. In fact, Dr. Klein at my nail salon, they recommend Dr. Jeffrey B. Klein if you have any kind of foot issue because it's very important because our next topic is diabetic foot care. But let's go back, people are trying to remove an ingrown toil by themselves, what is your procedure for when we come to see you for an ingrown toenail, what really happens with Dr. Klein?

Dr. Jeffrey B. Klein: Okay, so it depends if it's infected, it depends if it's come before and then it's gone and comes back again, that type of thing. So we evaluate the patient, whether it's a child or an adult, a senior citizen, we’ll basically evaluate their circulation, make sure they have good circulation to their toes, and then we remove the corner or the offending border of the toenail. So you're not removing the entire toenail, but just a sliver in the corner of the toenail. At that time, we go ahead, if it's something that's come back over and over again, sometimes we'll actually put a medicine in there so the corner of the toenail does not grow back. Not the entire toenail, the entire toenail is there, it's just a little narrower. And 9 times out of 10 or 9.8 times out of 10, it will never grow back the in portion of the toenail. And therefore you won't have more pain or infection. Sometimes if infection is present, you need antibiotics. Sometimes we do home soaks with different types of antibacterial such as white vinegar or warm soapy, it just depends on the condition. But this is something that's done in the office several times a day because ingrown toenails are so common. 

The problem becomes if somebody has an infected ingrown toenail and they leave it go, they live with the pain, or if they're a diabetic and they have neuropathy or numbness in their feet, then they don't feel it, they don't check their toes and it becomes infected. When it becomes infected over a long period of time, the infection can actually go deep down to the bone. And of course you wanna avoid things like that. You wanna get this treated as soon as possible because if it does get infected down to the bone, then there is a much more aggressive type of treatment. We work with infectious disease doctors who will often of times start these patients on antibiotics for a long period of time, whether it's given by mouth or whether it's given in an iv. Sometimes it requires even more types of surgery. Patients who have poor circulation or as diabetics sometimes require debridement or basically removal of a portion of the infected bone. These are in extreme cases, and this can really be avoided by looking at your feet every single day of your life. And if you see a problem coming into the office, sometimes there's just a very simple fix for it by allowing me to trim out the corner of the toenail versus doing some type of procedure. So do not let infections linger and think they’re going to go away because sometimes they will, but sometimes they won't.

Colleen Young: What is the difference Dr. Klein, when you have an ingrown toenail and it gets infected? What is the difference between that infection and something like a foot ulcer? Is it completely different? Are there similarities? What exactly is the difference between the foot ulcer and an infected ingrown toenail?

Dr. Jeffrey B. Klein: Okay, so an infected ingrown toenail is the corner of the toenail or the pointed part of the toenail, irritating the nail fold or the fatty part on the side of the toe, which causes irritation, or a break in the skin. And the skin, remember, is a natural barrier to infection. Once it does that, infection can get in. If you're not a diabetic and you're a young child, it's a very simple way to take care of this. When you talk about ulceration, that's a whole different subject. And it's usually seen in people who are diabetics, who have poor circulation, who have bad varicose veins that can lead to ulceration, and who also have poor circulation. And it's usually caused by the way you walk, the bony anatomy of certain people who have hammer toes or bunions or bumps and lumps on top of their feet or on the bottom of their foot that is irritated. The skin can break down to the walking or the rubbing of shoes or both. And the skin, once again, is the natural barrier to infection. Infection can get deep down into the bone or into the soft tissues and require aggressive treatment.

Colleen Young: Dr. Jeffrey B. Klein, as always, more information. I can't tell you how much the listeners and I appreciate you taking the time outta your busy schedule to come here and talk to us. Ingrown toenails are a serious thing, we need to come see you. I know I'll be there yet again in your office and can't wait to talk to you again. I understand that diabetic foot care is another topic that you are a subject matter expert on, so looking forward to talking to you again soon. Thanks Dr. Klein. 

[Extra] Hi everyone. Welcome to Head to Total, our podcast that pulls back the curtain on all things medical. You know him, you love him, he's back, it's Dr. Jeffrey B. Klein podiatrist with Mendelson Kornblum Orthopedics. And today, it's a very serious topic, Diabetic Foot Care. There's a lot of information that Dr. Klein's gonna share with us today. It's gonna be a great podcast, so stick around. Dr. Klein, as always, great to have you on the show, looking forward to this discussion.

[Extra] Hi everyone, welcome to Head to Total, our podcast that pulls back the curtain on all things medical. A great episode again today because you know him, you love him, he's back. It's Dr. Jeffrey B. Klein. Very serious topic today guys, it’s Diabetic Foot Care, and it is something that I never knew all the ins and outs of, so we’re just gonna hit the tip of the iceberg today.  Dr. Klein has some great information to share with us today. We can’t thank you enough, Dr. Klein, as always, for taking time, and coming to see us here at Head to Total. Can’t wait to talk to you about this subject.