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Feb. 14, 2017

By Cynthia Hemesath, DPM

How can you tell if that spot on your foot needs to be seen by a Podiatrist? There are a few simple questions you need to ask yourself.

Does it itch? Does the spot have scalloped or irregular borders? Does the color of the spot appear lighter or darker in the middle compared to the border? If you answered yes to any of these questions, you should call your Podiatrist for evaluation of the lesion.

When you visit coastal areas, you may notice more people wear flip flops or go barefoot to stay cool. Even though the sun provides us with great Vitamin D (which helps with muscle aches and fatigue), too much sun can cause skin burns which in turn can promote cancerous cells. The feet are prime targets for melanoma.

Anytime you notice a lesion between the toes or on the underside of your feet (where the sun does not shine), precautions should be taken to ensure melanoma is not the underlying cause. Generally when a patient notices a “new” mole on their feet, I measure, take a picture for their files and have the patient come back in six months to compare for any color or size changes.

Many times there are no differences and we continue to watch for changes. If changes have occurred or if the patient has any discharge or skin irritation from the area I will obtain a biopsy to identify or diagnose the skin lesion. Most times the lesion is not cancerous.

So let’s discuss some South Texas Coastal Bend “critters” that love to enter at our feet and cause problems. I might see a patient with a raised serpiginous, pruritic, erythematous area on the dorsal area of their right foot. In layman’s terms, that means a raised, snake-shaped, red, itchy, swollen area on the top of the right foot.

But if you have ever been infected by cutaneous larvae migrans, the word itchy does not come close to describing the feeling. Patients infected with this parasite have excruciating, constant itching. There are medications that kill the parasite with very few side effects, but a discussion of how to avoid this parasite might prevent you from experiencing this particular itchy coastal bend helminth (worm).

A dog or cat sheds the eggs of this worm through their feces to the soil, usually sandy areas or beaches. The eggs mature to larvae where they infect humans by direct contact. The larvae burrow into intact skin and are limited to the upper dermis since humans are an incidental host.

This disease is the most frequent skin disease among travelers and inhabitants of tropical areas. It is advised when walking on the beach to wear shoes, and when napping on the beach to lay on mattresses or thick foam pads. Towels are not enough to keep the parasites from the skin. If the beach is open to pets, the chances of parasites in the area are favorable.

Unfortunately sandals do not protect the top of the foot from these hookworms. All the cases I have diagnosed have been either on the top of the foot or the posterior legs. The infected area itches due to our body’s defense system fighting the parasite. Scratching could cause secondary bacterial infections and many times a skin eruption (much like poison ivy) can develop due to an allergic skin reaction to the parasite. Treatment with oral medications is very effective and if treated quickly usually will not leave a scarred area.

Finally, let’s discuss skin cancers on the feet and toe nails. Color, size and shapes are prime red flags as discussed earlier. But were you aware that melanoma can affect the toenails?

Many people are not aware that a discoloration of the nail bed may actually be a life-threatening melanoma. If you notice a discoloration that begins at the matrix (bottom) of the nail just under the cuticle area that extends up the nail to the end of the toe, and you have not injured the toe, you need to have it seen by a Podiatrist.

Remember early treatment can save lives. Many people forget to include their feet and toes when applying sunscreen. Melanoma can affect all parts of the body. So if you have unexplained discoloration of your toe nails, make an appointment with your podiatrist for your medical safety.

Cynthia Hemesath, DPM, earned her medical degree from the Dr. William Scholl College of Podiatric Medicine in North Chicago, Illinois. She completed her residency at New Mexico VA Healthcare System, where she also completed a surgical residency and served as chief resident for two years. She is an international speaker with the Foot and Ankle Foundation and a diplomat of the American Board of Podiatric Medicine.

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