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James P. Licandro, D.P.M.
A Podiatrist a specialist who is licensed and trained in the medical and surgical treatment of disorders of the foot and ankle. After a residency program, he/she can go on to become Board Certified by going through extensive testing. When looking for a podiatrist, you want to find one that is Board Certified in Podiatric Medicine and Podiatric Surgery. How many years of schooling does a Podiatrist undergo? Similar to other physicians, a podiatrist will complete a four-year Bachelor's degree. The Podiatrist will study four additional years of podiatric medical school to obtain a Doctorate of Podiatric Medicine (D.P.M.) degree. After graduation, a residency program varies from 1- 3 years. When should I seek help from a Podiatrist(foot specialist)? Any pain in the foot or ankle is abnormal and would mean there is a problem for which you should see a Podiatrist. If there were any visible problems of the foot, ankle or nails, a person would want to seek professional attention. People with diabetes should see a Podiatrist on a regular basis in order to help prevent complications that can often occur from systemic effects caused by diabetes. Why does Dr. Licandro want to know my past medical history? The doctor needs your complete past medical history, as it will help Dr. Licandro assess the problem for which you came to the office. This will help the doctor make a decision about the best treatment options for your personal situation. Just as with your complete medical history, it is necessary for Dr. Licandro to have a complete list of the medications that you are taking. Many medications have interactions that could be harmful to you. Our staff appreciates your positive co-operation in obtaining your complete medical history and obtaining a thorough list of medications that you are taking. Why do diabetics need to see a Podiatrist? Diabetes is a systemic condition that affects many organs and systems in the body. One of the first places where the effects of diabetes are seen is in the feet. This is due to the fact that the feet have the poorest circulation in the body due to both the effects of gravity causing the blood to pool in the feet and also because the feet are the furthest away from the heart of any structure in the body. It is a well known fact that one of the first systemic conditions that diabetes effects is the circulatory system. Podiatrists specialize in disorders of the foot and ankle and therefore are highly trained to examine for abnormalities of the lower extremity. Many times podiatrists are the first doctors to diagnose vascular disease, and neuropathy (numbness, burning, tingling, pain) in the lower extremities. Diabetes can cause both of these systemic disorders and by seeing a podiatrist, the feet, which are most affected by diabetes, can be cared for on a regular basis. Often a small problem can be diagnosed and treated at an early stage and helps prevent the condition from progressing to a more serious disorder. Why are diabetics at a greater risk for limb loss? Diabetes affects the circulatory system and the lower extremity is the first place this condition is seen. This is due to the fact that whether one has diabetes or not, the feet have the poorest circulation due to the feet being the furthest structures from the heart and also because the blood in the feet has to work against gravity to get back to the heart. As circulation is often compromised in diabetes, the feet and lower extremity are at an even greater risk for infections. An infection as minor as a small cut may take much longer to heal up in a person with diabetes. This is due to not only the compromise in circulation that is often noted in diabetes, but also to the effect diabetes has on the immune system. Diabetes can alter the immune system to the point to where the body cannot properly fight off an infection. Without proper medical attention, a very minor problem can often turn into a major concern and condition. Diabetes has often been called the "Great Masquerader" because it mimics many other medical conditions. Because of this, diabetes is often diagnosed much later than when it first occurred in the body and can lead to further systemic effects. What is the Medicare Diabetic Shoe Program? Dr. Licandro has a strong interest in Diabetes and the best treatment protocol for his patients with Diabetes. For sometime now, diabetic foot wound infections has been one of the leading causes of hospital admissions and accounts for a high percentage of the reason for lower extremity amputations. In order to help combat this growing disease, in 1993, Medicare approved a therapeutic footwear program for people with Diabetes. The program was designed for people with diabetes to be fitted with proper shoe gear and inserts to help not only provide proper fitting shoes, but also to help off load pressure spots in shoes that sometimes lead to corns or calluses. These diabetic patients can qualify for one pair of shoes and three pairs of custom inserts per calendar year. Medicare pays 80% of the total cost. If the patient has a secondary insurance, there is no cost to the patient. Under the Medicare guidelines, the patient needs to be seeing a physician on a regular basis for Diabetes in order to qualify for the program. This physician will be sent a certification form to be signed so that Medicare will cover these specifically approved shoes and inserts. Area Wide Foot and Ankle Center has the approved shoes and inserts. The Doctor or one of our highly trained staff will fit you for these therapeutic shoes. Our office completes all the necessary paper work and insurance for this highly effective program. As you may not be familiar with Dr. Licandro, he is a Board Certified Wound Care Specialist and is a member of the American Diabetic Association Educator Program. He is also Board Certified in Podiatric Primary Medical Care and Podiatric Surgery. As a diabetic, how should I care for my feet? It is extremely important to exam your feet daily and check for the following conditions: (If you cannot see the bottom of your foot, lay a mirror on the floor and hold your foot above the mirror to see the bottom.)
See your doctor immediately if you experience any of these conditions. Recognizing a problem and having it treated early is the MOST important factor. General Foot Care
Where to find out more information:
Nail thickening can be caused by internal problems, infections or shoe pressure. A fungal infection can cause nails to become thick, yellow or crumbly. Internal condition, including Diabetes, psoriasis or lack of circulation (Peripheral Vascular Disease) may cause abnormal nail growth. Poorly fitting shoes that cause continuous pressure on nails can also cause abnormal nail growth. What causes an ingrown toenail? An ingrown toenail occurs most often on the big toes. There are other factors but the most common cause is that the nail was cut back too short and starts to grow into the skin around the nail border. The nail becomes trapped in the skin and eventually may cut the skin where the leading edge of the nail is advancing due to normal nail growth. The nail grows deeper and deeper into the skin and can't grow out. It is even thought that there is a family predisposition to having ingrown nails. Infection is common with ingrown toenails. Often this occurs because a person tries to do their own "bath room surgery" to try to relive the pain. Infections in a toe can be very serious as the bone of the toe is so near the surface. Bone infections are very hard to treat and can result in losing a toe or part of a foot. A minor surgical procedure may need to be done to take care of an ingrown nail. This is usually not done if an infection is present. Antibiotics need to be taken to clear the infection first. What causes corns and calluses? Corns and calluses can be uncomfortable to painful. They are often caused by shoes that fit poorly and rub excessively on the skin of the foot or toes. They can also be caused by abnormalities in the structure of the bones and misalignment of the joints in the feet such as hammertoes or bunions. Warts are caused by a virus that often mimics a callus if on the bottom of the foot or a corn if on top of the foot. Often, there are dark spots in the center of the lesion that are further signs of a viral infection. A wart many times will be more tender squeezing it side to side than direct pressure. There are many treatment protocols for warts depending on the size and location of the viral infection. Treatments available include: chemical application, freezing, burning, surgical excision, and laser excision. Gout is a very painful inflammation that can occur to any joint in the body. The joint most often affected is the great toe joint. Gout is an accumulation of uric acid that occurs in the joint and turns from a liquid to a solid resulting in the deposits of small crystals. A gout condition can be so painful at times that even the weight of the bed sheets can cause extreme pain on the affected joint. Gout can be brought on by several different conditions. There can be a predisposition to acquiring gout if there is a history of gout in the family. Diet has also been known to bring on gout. Items such as: fish, red meat, and beer have all been shown to help bring on a gout attack. Often a change in diet and temporary use of prescription medication can help to relieve the gout symptoms. Sometimes, long-term medication is needed in order to control the gout from reoccurring. What are orthotics & how can they help me? Orthotics are inserts that go inside shoes to help correct abnormal walking patterns. These are not prefabricated arch supports that are readily available over the counter at most drug stores. Instead, orthotics are made from a mold that is taken of your feet. The molds are sent to an orthotic lab where they are specially made not only to the contour of the bottom of your feet, but also with any special accommodations needed to correct the abnormality in the gait pattern. Orthotics can help to treat many conditions including: heel pain, corns, calluses, ankle, knee, hip, and even lower back pain.
What treatments should be sought following a puncture wound? The first step is to remove the offending agent if it is a superficial injury. If the injury is very deep, it is sometimes better to leave the object in place as removing the object may result in serious blood loss. Seek immediate medical attention. If the injury is not deep and the offending agent can be removed, the next step is to control bleeding. This can be done by applying pressure to the wound. Cleanse the wound with hydrogen peroxide or rubbing alcohol if available. Cover the wound in antibiotic ointment and a band-aid. If the object was dirty or rusty as from a puncture wound from a nail, there may be a risk of a tetanus infection. If this is the case, seek medical attention right away as a serious infection can result if you are not current on your tetanus vaccination. The wound may need stitches if deep and may result in scar tissue if the wound is not properly treated in a timely fashion. Scar tissue can result in long-term irritation in the feet depending on the location of the wound. How should I properly trim my toe nails? Nails should be cut straight across and not too short. The proper length of the nail is when the border or edge of the nail is just over the skin. If the nail is cut shorter, it is very possible and likely to result in an ingrown toenail as the nail will then try to grow into the skin and may cause an infection. The average person takes about 9,000 to 10,000 steps each day. Those steps add up to 120,000 miles in a lifetime. If you had the time you could use those steps to walk around the middle of the globe four times. Our feet sweat about a half a pint every day because we have 250,000 sweat glands in our feet.
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Area Wide Foot and Ankle Center
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