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Posts for: May, 2013



With warmer weather approaching, us women are starting to put our winter boots away and take out our sexy high heeled shoes. High heeled shoes can create a sexier, more flattering figure by tilting the hips, accentuating the bust-line and making the legs look longer. However, high heels can cause a great deal of discomfort: High heels can cause calf pain, heel pain, Bunions, corns, calluses, Ankle Sprain, neuromas, Hammertoes, pump bumps and pain to the ball of foot (Metatarsalgia (foot pain in ball).


How do I encourage women to wear more sensible shoes? It's almost impossible. I do tell my well-heeled patients to limit their time spent in heels-never all day, just for a few hours. I also instruct them to buy shoes at the end of the day that fit comfortably across the widest part of the foot and wear gel or silicone insoles for a comfortable cushioning effect as well.


Written by: Dr. Jennifer Zienkowski-Zubel, DPM


If you have any questions or concerns please do not hesitate to contact 1 of our 3 offices.

Our Offices


Middleburg Heights Office: Phone (440) 243-1473

Lyndhurst Office: Phone (216) 382-8070

Beachwood Office: Phone (216) 591-1905








Skin cancer can develop anywhere on the body, including the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.


We often view the sun’s harmful rays as the primary cause of skin cancer, due to the fact that the condition is often found on parts of the body that receive the most sun exposure. While this may be true of some bodily skin cancers, it does not hold true for those that arise on the skin of the feet. Skin cancers of the feet are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities which might be indicative of evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the lower extremity are:

Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body.  Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and are similar in appearance to an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma 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 often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally, it begins as a hard, projecting, callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common dermatological conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Nonsurgical treatments are rarely effective and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.

When to Visit a Podiatrist

Learn the ABCD's of cancer. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:

•Asymmetry - If divided in half, the sides don't match

•Borders - They look scalloped, uneven, or ragged

•Color - They may have more than one color. These colors may have an uneven distribution

•Diameter - They can appear wider than a pencil eraser (greater than 6 mm). For other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or "donut-shaped" edges, or discrete scaly areas

Diagnosis and Treatment

The investigation for skin cancer will be done through clinical examination and skin and/or punch biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist examines the tissue in greater detail.  If a lesion is determined to be malignant, your podiatrist will recommend the best course of treatment for your condition.

If you or someone you know has a questionable lesion, please give 1 of our 3 offices Our Offices a call for further evalaution and treatment.

Informatoin provided above can be found at APMA and/or BAKO Labs.





Managing diabetes can be tough. This is especially true when you begin to notice new symptoms. You may be wondering if these symptoms could be related to your diabetes.  The answer could be yes.  The American Diabetes Association reports that about 50% of people with diabetes have some form of nerve damage know as diabetic neuropathy.

In the early stages of diabetic neuropathy, you may have no signs or you may have numbness or tingling in the hands, feet, or both. Because nerve damage can occur over several years, these cases may go unnoticed. You may only become aware of neuropathy if the nerve damage gets worse and becomes painful.  Pain caused by nerve damage from diabetes is often called "diabetic nerve pain."

"Diabetic nerve pain" is a growing problem.  About 8% of Americans have diabetes. Unfortunately, this number is only growing. As would be expected, the number of people suffering from diabetic "nerve pain" has also increased.

  • It is estimated that more than 25 million Americans are affected by diabetes
  • Diabetic "nerve pain" is a common diabetes complication, as are kidney and eye (retinopathy) 
  • Approximately 21% of patients with diabetes have diabetic "nerve pain"
  • This adds up to 5 million Americans with diabetic "nerve pain"

Nerve pain is not the same as other types of pain you may experience, therefore, requires specialized testing.  This test being Epidermal nerve fiber density (ENFD).  This test is utilized to determine the presence, and the degree, of small fiber peripheral neuropathy and rule out large fiber involvement.  This test additionally provides an objective baseline prior to the initiation of therapy by your physician, with repeat of the test within 6-12 months to assess disease progression, or alternatively, disease regression.  The test results provide pertinent information to your doctor, which allows a specialized treatment regimen.  This treatment regimen can consist of Metanx.  Metanx provides the nutritional requirements needed by patients with diabetes to restore the metabolic processes associated with "diabetic nerve pain" to mmaintain blood flow in the blood vessels that carry the nutrients and oxygen to your nerves and pprovide the required nutrients to help facilitate nerve repair including production of the myelin sheath, a substance that insulates and protects nerve fibers.

If you or someone you know has "diabetic nerve pain," please contact 1 of our 3 offices for further information or evaluation:


Middleburg Heights Office: Phone (440) 243-1473

Lyndhurst Office: Phone (216) 382-8070

Beachwood Office: Phone (216) 591-1905






Taking a minute or two every day to inspect your feet and observing a few simple rules can make the difference in sparing diabetes patients from a preventable outcome of the disease – a foot amputation.


Of all diabetes-related complications, a serious foot ulcer and subsequent amputation might be the most preventable with proper care and vigilance in checking the feet at least once a day for small cuts and other abrasions. Even those with good control of their blood sugar can experience foot ulcers, especially if neuropathyNumbness and Tingling, a frequent diabetes complication, has caused decreased feeling on the bottom of their feet.


Loss of sensation inhibits the body’s normal pain response. As a result, walking can apply repetitive, unfelt pressure to a wound, making it larger and deeper. Left untreated, diabetic ulcers lead to serious infections, which may result in amputation.


A variety of surgical and non-surgical methods to heal diabetic ulcers, but stressed early intervention yields the most favorable outcomes.


Daily self exams are the best protection. Too often, patients fail to check their feet for small cuts or punctures that over time will ulcerate and become infected. If you have diabetes and see anything suspicious on your feet, consult a foot and ankle surgeon for diagnosis and treatment. Even a few days can make a difference in preventing serious foot problems from developing.


An estimated seven in ten diabetes patients have nerve damage that impairs feeling in their feet. Fifteen percent eventually will develop a foot ulcer. Among those with ulcers, one in four will lose a foot. Each year more than 86,000 amputations are performed as a direct result of diabetes, and studies show half of those who have one foot or leg amputated will lose the other within five years. Proper diabetic foot care, prevents foot loss.Diabetic Foot Amputation Prevention


In some cases, amputation might be the preferred option. If vascular and podiatric surgeries can’t improve blood circulation and foot function, resolve infection or restore foot function, amputation may be the only solution that enables the patient to heal. Today, advances in prosthetics make it possible for patients to return to an active lifestyle, a necessity for keeping diabetes under control.


Foot problems are not an inevitable consequence of diabetes. The risk can be lessened significantly by following a few simple precautions:


â–  Keep your blood sugar under control to help minimize cardiovascular and blood circulation problems

â–  Lose weight, don’t smoke and adhere to prescribed dietary, medication and exercise regimen

â–  At least once a day, examine your feet for cuts and other small wounds you may not feel

â–  Never walk barefoot, outdoors and indoors

â–  Wash your feet every day in lukewarm water; dry carefully

â–  Choose comfortable shoes with adequate room for the toes

â–  Wear clean, dry, non-bulky socks; change daily

â–  Shake pebbles or bits of gravel out of your shoes before wearing

â–  Seek treatment from a foot and ankle surgeon if minor cuts and sore spots don’t seem to be healing


Written by: Dr. Jennifer Zienkowski-Zubel, DPM

If you or someone you know is a diabetic please contact 1 of our 3 offices( Our Officesfor a diabetic foot check, it will help in preventing an amputation.



Middleburg Heights Office: Phone (440) 243-1473

Lyndhurst Office: Phone (216) 382-8070

Beachwood Office: Phone (216) 591-1905



May 02, 2013
Category: Uncategorized
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With sandal season approaching, you might be wondering how to eliminate odor caused by smelly feet.


Smelly feet is the result of excessive activity of certain germs which live on our bodies. Foot smell is affected by many factors and all of these can usually be controlled.


The problem is that your feet tend to live in a dark, warm, moist environment. The germs that thrive in these conditions cause the break down of perspiration on the skin and produce the foot odor that most of us know as smelly feet.


A number of foot odor control products exist. Initial treatment of foot smell odor involves:

Washing the feet daily with an antimicrobial soap. This may seem obvious but it is surprising just how little time is spent attending to this task. We often think that because the feet get wet in the shower, then they must be clean. Feet do require a little extra care and this is certainly the case if you suffer with foot smell odor.


Natural fiber socks are important in helping to improve moisture absorption and airflow. When purchasing socks or hosiery, look for wooll or cotton products where the percentage of natural material is over 80%. This will help in preventing foot odor.


Leather shoes are best when trying to prevent foot smell. Synthetic uppers on shoes restrict airflow. If you wear sneakers, try using those with an open weave fabric upper to improve airflow.


Foot antiperspirant sprays. These act in a similar way to those used under the arms.


Foot antiperspirant powders. Excessive perspiration may be caused by systemic or hormonal imbalance which means consultation with a Podiatrist is advisable if you suffer with a foot smell complaint. In the absence of any systemic problems, your Podiatrist may recommend special foot baths with special additives to help reduce perspiration and foot odor. This should only be carried out under close supervision with your Podiatrist.


Written by: Dr. Jennifer Zienkowski-Zubel, DPM


For further advice on smelly feet and other common foot complaints please contact 1 of our 3 offices for a consultation:Our Offices



Middleburg Heights Office: Phone (440) 243-1473

Lyndhurst Office: Phone (216) 382-8070

Beachwood Office: Phone (216) 591-1905