We are lucky to have Ariel Mortera, PT and AIMS Physical Therapy join the James Medical Center. Ariel is one of the best physical therapists that we have worked with and we recommend him without reservation to our patients in need of physical therapy. Ariel is always happy to help our patients attain their treatment goals. His physical therapy treatment regiments help with stretching, strengthening, decreasing inflammation, improving swelling and circulation, as well as aiding in balance and gait. We are also partnering with AIMS to offer our athletes and runners an evaluation of their running form in Runners Clinic.
You can reach Ariel at 708-397-4010 with questions or to schedule an evaluation. His website is http://www.aimsphysicaltherapy.com/

We now offer FDA appoved laser treatment of nail fungus

At Advanced Podiatry Clinics, we are your west-suburban Chicagoland specialists in the laser treatment of nail fungus or onychomycosis with the Cutera laser system.  We offer our patients maximally effective results without the risk of liver damage from months of taking oral antifungal medication Dr. Claude Harb, is our Cutera laser specialist, with extensive experience in the treatment of nail fungus. Please contact our office at (708) 450 - 0705 for more information.

1. What is nail fungus or onychomycosis? Nail fungus or onychomycosis is a fungal infection of the nail plate, nail bed, and nail matrix that effects millions of people. The infection is usually caused by Trichophyton rubrum species, which can be seen as septated hyphal elements on a KOH prep, as bellow.  Often this fungal nail infection manifests in thickening, discoloration, brittleness, and nail debris.  Certain conditions such as chronic fungal skin infections, like Athlete’s foot, or diseases which affect your immune system, such as diabetes, can put you at a higher risk to develop onychomycosis.

                                  
                                         KOH wet prep of a fungal nail specimen at Advanced Podiatry Clinics

2. What is the Cutera laser treatment for onychomycosis? This novel treatment of nail fungus, FDA cleared since 04/07/2011, uses a 1064 nm wavelength of laser light to kill onychomycosis causing fungus in the nail plate, nail bed, and nail root. The laser is able to penetrate up to 3 mm in depth to ensure that all fungus and fungal spores are destroyed, without any pain or damage to the human tissues.

3. What other options are available for treatment of nail fungus? Prior to the invention of the laser treatment for nail fungus, the options for the treatment of this stubborn condition were extremely limited. They included the application of topical anti-fungal medication for years with minimal, if any results. The other option included taking an oral anti-fungal medication, such as terbinafine or itraconazole, for an extended period of time with risk of damage to the liver. Furthermore, patients with a history of liver disease or taking certain other oral medications, were not candidates for oral treatment.

4. How effective is the Cutera laser treatment? Studies show an 81% “complete” to “moderate” clearance of resistant onychomycosis with the Cutera Laser, with no side effects*. At Advanced Podiatry Clinics, from our experience the success rate has been even higher. The efficacy is significantly higher than topical or oral medications.

* Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y. J Drugs Dermatol. 2012 Apr;11(4):496-504.

5. What will my treatment consist of? Your treatment will consist of an initial evaluation by Dr. Igor Dukarevich or Dr. Claude Harb to make sure that you are a candidate for the laser treatment of onychomycosis with the Cutera laser system.  Clinical photographs will be taken. We will also confirm the presence of the fungal infection either by a KOH stain directly in our office, or a by a PAS stain and fungal culture performed by Bako Pathology Services. Your nails will be debrided and filed down to the optimal thickness for laser penetration. During your visit, your shoes will be sanitized with an ultraviolet shoe sanitizer.  The Cutera laser treatment will be performed by Dr. Claude Harb, our specialist in the Cutera laser nail treatment.  For a video of a treatment, please click here.  Three treatments have to be performed: the first at the initial visit, the second at 3 weeks, and the third at 3 months, to make sure that all fungal organisms and fungal spores are eradicated.  You will also receive a shoe spray and a cream to prevent future reinfection.

 
6. How soon will I see results? Two to three months after the Cutera laser treatments, you will start to see the new and healthier nail grow from the nail root. For maximum improvement, you will need to wait for the nail to fully grow out, which may take up to 9 to 12 months. A chronic fungal infection often damages that nail root and the nails may grow even slower.

7. What should I do to prevent reinfection? Prevention of reinfection is a major part of your treatment.  After your treatment with the Cutera laser, you will need to follow preventative instructions closely.

-          Previous foot condition, such as Athlete’s foot, bromhidrosis (smelly feet), or hyperhidrosis (sweaty feet), need to be addressed with your treatment

-          Always use socks from natural fibers such as cotton or bamboo

-          Always wash your socks in hot water, adding chlorine if they are white

-          Sanitize your shoes regularly either with the antifungal shoe spray or an ultraviolet shoe sanitizer dispensed from our office

-          Allow your shoes to “air out” for at least 24 hrs between uses

-          Avoid contact with fungal organisms: never where someone else’s shoes, avoid walking  barefoot in public areas, and always use flip-flops in public pools and showers

8. Is this a covered procedure under my health insurance plan?
At this point, most insurance carriers consider onychomycosis to be a cosmetic disorder and strictly limit the coverage of the treatment. Laser treatment of onychomycosis is usually a non-covered service. You should check with your insurance company individually to inquire about your benefits. Often, this service can be covered with a flex spending account.  Advanced Podiatry Clinics will provide you with a service receipt after your treatment, which you may submit to your insurance company. Please call our office at (708) 450-0705 for more information on cost of the treatment, coverage, and scheduling.

For your convenience, Advanced Podiatry Clinics now offers Saturday morning hours.

Winterizing your FEET

      Winterizing Your Feet  

   

Season Greetings from Advanced Podiatry Clinics! This season brings us cold temperatures, snow, ice, low humidity, all of which may cause or exacerbate certain lower extremity medical conditions. We frequently see patients with xerosis, dermatitis, frostbite, Raynauds disease, burns, and fractures in our clinic during this season. 

 Many people winterize their cars and homes. Dr. Dukarevich and Dr. Harb recommend the following easy tips to "winterize" your feet this season and avoid any foot problems.
 

• Examine your feet daily for any cuts, sores, cracks, calluses, swelling, redness, drainage
•  Check on the bottom and between the toes

•  If you have trouble getting to your feet, ask a friend or a relative to help

• Use special foot creams with lactic acid or urea, such as Flexitol Heel Balm, at least twice daily
• Avoid putting cream between the toes

• Avoid soaking your feet or bathing in hot water frequently or for prolonged periods of time
•   When taking a bath check the temperature of the water with your elbow before stepping in

• Do not walk barefoot around the house or in open-backed slippers
•  Use clean white cotton or wool socks
•  Change socks daily or more often depending if your feet sweat a lot

• Avoid tobacco and alcohol use

• When going outside in cold weather, wear clothes and shoes appropriate for the temperature
• Wear warm loose-fitting clothing, gloves, and socks to avoid compression of digits
•  Use well-fitting supportive shoes with good traction on outer soles
•   Try a shoe traction device if you plan to walk far in the snow or ice

• Avoid prolonged exposure to cold temperature -- be extremely careful when walking outside in icy or wet conditions 

•  If you get your socks or shoes wet outside, remove and change them as soon as possible
•  Allow wet shoes to dry thoroughly for at least 48 hrs before putting them back on
•  Do not use radiators or space heaters to warm your extremities 

• Seek medical attention if you have any questions or concerns
• If you have diabetes, poor circulation, or other systemic disease, you may benefit from routine screenings and foot care from your podiatrist
• You can contact us by phone at 708-450-0705 or through our website at  www.advpod.com

Advanced Podiatry Clinics and Staff wish everyone a happy and safe Holiday Season! 

Diabetic Foot Care

Diabetic Foot Care

At Advanced Podiatry Clinics, we frequently treat patients with foot and ankle complications secondary to diabetes.  Diabetes affects many organ systems in your body including nerves, blood vessels, immune system, musculoskeletal system, and your ability to heal. Due to these reasons, people with diabetes have to take special care of their feet.

Many people with uncontrolled diabetes develop diabetic peripheral neuropathy, a condition which causes a gradual loss of sensation in the lower extremities. People simply do not feel if they step on something sharp, if their shoes are rubbing, or if they develop calluses,ulcers, or infections. These sensory changes are gradual and go unnoticed by most people. Neuropathy also could contribute to deformity of the feet, such as hammer toes, changes in your gait, and dryness of the skin.

Occasionally, patients may develop tingling, burning, or shooting sensations in their feet, which is known as painful diabetic peripheral neuropathy. These sensations occasionaly become quite painful and may interfere with normal sleep during the night. To help with the diagnosis, Dr. Dukarevich will occasionally order nerve conduction velocity and electromyography studies (NCV/EMG).

For our patients' conveniece, Advanced Podiatry Clinics closely works with NeuroTrans(http://neurotransdiagnostics.com/index.html) to offer our patients on-site nerve conduction testing in our office. Dr. Dukarevich will often prescribe topical over-the-counter, prescription, or compounded creams to relieve the burning, tingling, and shooting pain in the feet. Occasionally, oral medications may be necessary to relieve these painful symptoms.

In addition, diabetes contributes to blood vessel disease, called arteriosclerosis. The small arteries that carry the blood from your heart to all organs, including your feet, can narrow and become obstructed. The lack of blood flow makes it very difficult to heal ulcerations on your feet and in severe cases can lead to gangrene. Diabetes also slows down your immune system and makes it difficult for your body to fight infection.

Dr. Dukarevich and Dr. Harb recommend the following simple tips to avoid and prevent foot complications secondary to diabetes.

o   Maintain tight control of your blood sugar by seeing your endocrinologist or primary care doctor on a regular basis. Check your blood sugar regularly and take your medications as prescribed. An exercise regiment, special diet may also help to level your blood sugar.

o   Always use diabetic shoes and inserts, as prescribed by your podiatrist.

o   Use diabetic or white cotton socks and change them daily.

o   Do not walk barefoot.

o   Check your feet daily for any calluses, cracks, corns, rashes, or sores. Don't forget to check in between the toes.

o   Check your feet daily for any redness, swelling, drainage, warmth, or bad smell. These may be a sign of infection and you should contact your podiatrist immediately.

o   Check your shoes for any foreign objects before putting them on every day.  Give them a shake; you will be surprised what you find.

o   Check the temperature of your bath water with your arm or elbow before immersing your feet.

o   Apply an emollient cream to your feet daily to keep the skin soft and resilient. Do not apply any lotion in between your toes.

o   Do not attempt to cut or trim your own toe nails or calluses with any sharp objects. Using an emery board for your nails and a pumice stone on a regular basis may help to keep them from getting out control in between your visits. Do not use any over-the-counter corn removers.

o   See you podiatrist on a regular basis for diabetic check-ups, routine foot care, and diabetic shoes.

o   Please contact Advanced Podiatry Clinics at (708) 450- 0705 if you have any questions or concerns regarding your feet. We are also on line at www.advpod.com.






References:

1. Patient education for preventing diabetic foot ulceration.

Dorresteijn JA, Kriegsman DM, Assendelft WJ, Valk GD.

Cochrane Database Syst Rev. 2012 Oct 17;10:

2. Preventative foot care in people with diabetes.

American Diabetic Association

Diabetes Care January 2003 vol. 26 no. suppl 1 s78-s79

A big "Thank You" to the organizers of the Veterans Day 5K Prodigy Run in Melrose Park! Dr. Dukarevich and Dr. Harb had a great time, despite not breaking any records. The weather cooperated and we met a lot of fun people. Advanced Podiatry Clinics hopes to participate in a lot more local events and runs in the future.

Advanced Podiatry Clinics is now offering digital X-ray imaging! We are proud to provide superior quality digital images with shorter wait times for our patients. If you would like a copy of your images, we will now provide a CD for easier viewing, instead of copies of your films.