Doctor's Reply 博士信箱
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很抱歉此頁部份內容只有英文版本。 most recent post: January 23, 2010
Halo~我今年21歲,大約5歲已經有灰甲,試過食藥同茶藥水,但係都冇嘜改變,所以都幾十年冇理過d指甲,同埋加上呢一年黎自己都有gel甲,情況好似愈黎愈衰,d甲可以話俾我整到冇哂咁滯...我想問:有冇"人工甲植入手術"可以做??or有咩方法可以醫得快d好?拔甲係咪以後都唔會再生指甲出黎??
另外,我仲有一個好嚴重ge問題,係關於腳上表面皮膚,睇過醫生話係"遺傳"..{有個學名,不過我唔記得左,個醫生話暫時冇藥醫到,香港有呢個病GE人可能10個都冇}~好似d老人腳咁,又有d似燒傷(只係前小腿部分有事),整損左比一般人難止血+好耐先好返~
又想請問,有冇一種手術可以整到好似正常人ge皮膚??
Answer:
Thank you for your email inquiry!
Here is my opinions for your questions below:
人工甲植入手術
-- This type of surgery is not available in our clinic. It's still being developed even in the USA. Acrylic nails can serve the purpose in the mean time. (本診所現尚未有提供這樣的手術。在美國方面也正在研發中。暫時可以以樹脂甲代替。)
拔甲
-- This is a minor surgery, can be done in the office and walk out on the same day. Its your option whether you want the nail to regrow or have a permanent removal. Just let us know before the procedure. (這是一個小型手術，本診所亦有提供這項服務,同時可以即日自行離開本診療中心。你可以選擇讓腳甲再生或永久性切除。)
腳上表面皮膚
-- There are many different types of skin problems, its difficult to tell what you have. If you tell me the medical name, I may be able to provide more information. (其實皮膚病有很多種，如若可以知道學名，我們或許可提供更多資料。)
有冇一種手術可以整到好似正常人ge皮膚
-- This is the area of Plastic Surgery, which is not our specialty. They may be able to provide you with more informations. (這是屬於整型外科手術，他們或許可提供更多資料。)
Hope the above answers can help!
Feel free to contact us again for more informations!
我因為成日油甲油,又冇好好護理,所以腳指公邊左做灰甲 (Fungal Nail).
之後我搽左d 灰甲藥水.搽搽下. 我腳甲近肉果d 位開始林林地,
我好驚! 我問我屋企人,佢地叫我剪左佢,之後我真係剪左,我剪左大半個甲.e家個甲好嘔心,
我想問隻甲會唔會生返出泥架?有咩方法可以好返?
Answer:
Thank you for your email enquiry!
Your condition is quite common, and from our experiences, the nail usually will grow back, but may still be "gray."
However, without seeing the actual condition, I cannot make a definitive diagnosis.
What I recommend is:
1. stop using nail polish from now on for at least 1 month
2. do not use any over the counter fungal nail medications for now
3. do regular shower and daily filing of the nail
4. do not dig under the nail plate.
Toenail takes at least 6 months to grow from the bottom to the top so please be patient and wait.
I suggest you to come see us for a more definitive solution.
(sorry that I am not able to type Chinese, I will ask my assistant to type Chinese if you need to)
I saw that there is a mention of some sole for Diabetes patient. Is this a preventive measures?
What is that exactly ? And in what situation Diabetes patient requires that?
Thanks,
Answer:
Thank you for your inquiry!
One of the diabetic complications is Peripheral Neuropathy, i.e. problems with the sensation, and this usually begins at the feet. These patients may also have bone problems, calluses, etc, which combined with peripheral neuropathy may lead to ulcerations on the bottom of their feet. Therefore there are accomodative insoles for diabetic patients, main purpose is to protect and cushion their feet as they walk, as a preventive measure. Insoles are inserts placed inside the shoes, they are custom made to fit the need for each individual patient. Depends on the types and materials, they usually last 1-2 years. And if a person already developed wounds/ulcers, special insoles are also tailor-made to off-load the ulcer area and thus speed up the wound healing process.
Hope the information above helps!
Feel free to contact us if you have further questions!
Regarding Ingrown Toenail - is it an on-going thing that it keeps growing back even after operation(s) ?? I heard a case that a young chap had done this "Ingrown Toenail Operation" for 7 times, WOW. I myself had it when I was a kid and I just 1 operation and that's it, so it depends on how good the Dr. is or what ??
Answer:
Basically, there are two types of nail operation. The first operation is called partial nail avulsion which is to remove ingrown portion all the way back to the base. Then, use a simple method to prevent nail re-ingrown. Of course, there is no guarantee that it will success. The successful rate depends on the cause of ingrown nail.
The second operation is called " matrixectomy." After the partial nail avulsion, use either chemical or surgical method to destroy the matrix which is the tissues to grow nail. Only the ingrown portion will not regrow. Normal portion of nail is kept intact. The successful rate is partly depend on the doctor's technique.
Feel free to contact us for any further questions or details!
I have a son who is 1 year old and I'm wondering if you know of any brands of kids shoes that are good for the development of the feet for new walkers?
Answer:
In response to your question about shoes for new walkers, there is no specific brand that we recommended. However, here are some tips for finding the right shoes for your 1-year-old son:
1. Indoor: barefeet walking is preferred. Especially for kids who are learning to walk, they build the muscle strength and the sense of balance while they are trying to grasp the floor. Shoes may actually interfere such development. Once they can walk more normally, then soft shoes as described below are recommended for indoor as well, to prevent injuries to the feet, since children would like to walk and bump everywhere once they 'master' the walking skills :)
2. Outdoor: shoes that has soft tops (such as leather) and velcro are preferred. Also the inner sole should be soft, and the outer sole should be flexible at where the toes bend (i.e. at the ball of the foot). Rubber bottom has good traction, however, may be too much for beginning walkers, who may catch on things and fall. If a child tends to slip out of the shoes, then lace-up shoes or high-top shoes are recommended.
3. Shoe sizing: there should be extra room to fit 1 index finger regarding the length of the shoes. The heel should be snug fit into the shoe's heel counter.
Hope these information are helpful! Feel free to contact us again if you have further questions!
I have come across a U.S. shoe brand that promotes "walking bare foot" (for children under 3 years old) on the website. They claim their shoes have very very soft tops with a very flexible soles. I got a bit confused because I went to a shoe store one day and they told me that once a child can walk on their own properly (say around 15mths-3 years old), they should wear shoes that have more support for the heel/ankle area and the sole can be harder. Which theory is correct? When my child can walk very well on his own, is it still suitable for him to wear shoes that have very soft top (with flexible rubber sole) for outdoors or does he need a thicker sole? Is it necessary for children to wear shoes that support their heel/ankle area when they can walk in order to avoid 後足外翻?
Answer:
There can be different theories in terms of foot development and shoes fitting.
In a normal circumstance, children between the age of 2-4 are flat-footed. Their foot arches are flat and heels are everted (後足外翻). This position the whole foot touches the ground and gives them better floor gripping and thus better balance. As long as their flatfeet are flexible, i.e. the arch can be reproduced by moving the foot in a certain way, no special treatment is needed. Another reason for the flatfeet appearance is the so called 'baby fat' on the soles, which is particular thick and cushioning at very young ages. When a child stands up, the fat pad fills up the arch space, and thus the child looks flat footed.
At age 4-5 years old, children's arches and heels slowly re-position to a normal appearance, that is, arch height will increase, and the heel return to vertical. Only if a child after 5-6 years old and the foot arch still collapsed and heel still everted should consider orthotics and extra support shoes.
In my opinion, early arch support before 4 years old is not necessary. Shoes with firm heel counter is always helpful in foot protection, while it also reduce heel eversion, the functionality is not as important as protection at this age group. Soles of the shoes should be able to bend at the ball of the foot no matter now thick it is. My preference is thin but durable soles, thicker soles can cause tripping and catching on things.
Hope these are helpful as well!
I would like to inquire about Leg Length Discrepancy Adjustment. My discrepany is about 0.75 inch. It was discovered when I was young. In recent years the back pain is getting more serious so I would like to see if it is possible to make a custom foot orthoses to help the balance. How long do you think the first consultation will take?
Answer:
We will do a thorough examination, and also interview you if you have tried any orthotics or heel lift or any shoe modifications in the past. We also will do a gait analysis to see what other parts of your body may be mal-aligned secondary to the LLD. If you decided to get a custom foot orthosis, we can take a mold of your feet at the same visit. In other words, please expect the initial consultation to be around 1 hour including mold casting. It would be helpful if you bring in any devices you have tried in the past so that we can get a complete picture of your concerns.
Given the approximate discrepancy of 0.75 inch, do you think the custom foot orthosis can fit in my shoe? Or do you think heel lift or shoe modification is more appropriate?
Answer:
Usually for LLD, we would try heel lift (or full length flat insert) starting from 1/4 inch, and slowly increase the height so that the body has time to adjust to the changes. Sudden increase of 3/4 inch would definitely throw the body off and feel more uncomfortable.
Once you found the most suitable height (usually less than your actual LLD), then we can incorporate the height into the insert (its not until then we will order the orthotics). Depending on the type of inserts and the shoes you would use it with (such as dress shoes vs tennis shoes), the strategy is a little different.
Shoe modification is probably not needed for 3/4 inch LLD, as long as the shoe is deep enough to fit the orthotics, cosmetically it's much more appreciative as well. Hope these help!
California Foot and Ankle Medical Center 加州足科醫療中心