Teen Tips For A Fab Pedicure

Everyone needs a little foot pampering from time to time. Whether you're getting your toes ready for prom, prepping for beach season,or just want to splash on a bright color before a hot date, grooming your feet should be done frequently to not only keep feet looking good, but also to ensure proper foot health.
Here are a few pointers to keep in mind next time you get a pedicure at home or at a salon:
Don't shave your legs before receiving a pedicure. Resist the urge to have smooth legs, at least until afterward. Freshly shaven legs or small cuts on your legs may allow bacteria to enter your body.
Do bring your own pedicure utensils to the salon. Why? Because bacteria and fungus can move easily from one person to the next if the salon doesn't use proper sterilization techniques. Yuck!

Don't allow salons to use a foot razor to remove dead skin. Using a razor can result in permanent damage if used incorrectly and can easily cause infection if too much skin is removed.
Do use a pumice stone, foot file, or exfoliating scrub when eliminating thick, dead skin build-up, also known as calluses, on the heel, ball and sides of the foot. Be sure to soak your feet in warm water for at least five minutes and then use the stone, scrub, or foot file.
Don't apply nail polish to cover up discolored nails. Thick and discolored toenails could be a sign of a fungal infection. Nail polish locks out moisture and doesn't allow the nail bed to "breathe." If you think you have a toenail infection, schedule an appointment with today's podiatrist immediately to get it checked out.
Do gently run a wooden or rubber manicure stick under your nails. This helps keep your nails clean and removes the dirt, glitter, and other types of build-up you may not be able see.
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How To Pick Out Baby's First Shoes

Seems like yesterday that you were getting your first ultrasound and dreaming about taking your new baby home. Now your little one is crawling all over the place and getting ready to take their first steps. How did it happen so quickly? You've seen all of the cute options for first shoes, but how do you know what's good and what's not? Here are some tips in picking out baby's first shoes:
1. Don't Rush! Most new walkers don't need shoes right away when they first start to walk, unless it is outside. Barefoot is actually the best way for children to learn to walk. Children do not need shoes until they are actually walking.

2. Know Where To Go. And that does not mean Walmart or Kmart unfortunately. It is also not the time to hone your skill of shopping online. Your baby's first pair of shoes should be fitted by a professional, along which each pair thereafter. When shoes do not properly fit, it affects your child's gait and foot development. Go to a shoe store that will have a fitter on hand.
3. Get A Shoe With Sole. For walking shoes, babies need shoes with soles that are stiff because flexible ones don't offer any support. Do the bend test- if the shoe bends in half or twists, then try another pair. Don't worry about finding shoes with arch support as arches do not develop on children until they are three years old.
4. If The Shoe Fits, Wear It! The salesperson should do a thorough check for the proper fit, all around the baby's foot. There should be room for the foot to move in the shoe, along with a quarter to half inch space between the front of the shoe and the big toe.
5. Check and Re-check Those Little Piggies. Check your child's feet often after purchasing the shoes, especially after a growth spurt. Children are not typically good at expressing pain or what hurts where, so check your child's feet for redness and blisters. Imagine if you had a blister on your feet and couldn't tell anyone and had to wear those shoes every day?
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How To Give Yourself A Pedicure

In light of how dirty and unsanitary most nail salons and pedicure stations are, we recommend you try to do your own pedicure at home. Not only will you save your feet from fungus and Athlete's Foot, among other things, but you'll save a few dollars as well.
1. Soak your feet in warm and soapy water. We suggest five minutes- in the meantime chill and relax! Make sure to clean and dry off your feet thoroughly before proceeding.

2. Use a pumice stone to remove any calluses or dead skin. Don't forget to remove scaly skin and dry skin from your heels and balls of your feet.
3. Rub your cuticles with cuticle oil, olive oil, or baby oil. Afterwards, use an orange stick, which you can find at any drugstore, to push back the dead skin near the cuticles. You can also use the orange stick to clean under your toenails.
4. Now you can clip your toenails. We recommend getting specific toenail clippers with a straight blade to prevent ingrown toenails. Remember to cut your toenails straight across and trim them so you can see a little bit of skin past the nail.
5. Massage lotion or cream all over the skin of your feet.
6. Using nail polish remover, remove the lotion from your toenails. Now it's time for the fun part! Using your desired polish, start with a stroke down the center of your nail.
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Avoiding P.A.D. Complications, Part 4

Getting regular foot exams- as well as seeking immediate help when you notice changes in the feet- can keep small problems from worsening. P.A.D. requires ongoing attention.
To avoid complications, people with this disease should follow these precautions:

• Wash your feet daily. Use warm (not hot) water and a mild soap. Dry your feet- including between the toes- gently and well. 
• Keep the skin soft. For dry skin apply a thin coat of lotion that does not contain alcohol. Apply over the top and bottom of your feet, but not between the toes. 
• Trim toenails straight across and file the edges. Keep edges rounded to avoid ingrown toenails, which can cause infections. 
• Always wear shoes and socks. To avoid cuts and abrasions, never go barefoot- even indoors. 
• Choose the right shoes and socks. When buying new shoes, have an expert make sure they fit well. At first, wear them just for a few hours daily to help prevent blisters and examine the feet afterward to check for areas of irritation. Wear seamless socks to avoid getting sores.
• Check your feet- every day. Check all over for sores, cuts, bruises, breaks in the skin, rashes, corns, calluses, blisters, red spots, swelling, ingrown toenails, toenail infections, or pain.
• Call your foot and ankle surgeon. If you develop any of the above problems, seek professional help immediately. Do not try to take care of cuts, sores, or infections yourself. 

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PADnet Testing Part 3

A PADnet Arterial Test can provide early detection of P.A.D. when treatment options are broadest (incorporating both lifestyle modification, and non-invasive and invasive therapeutic options). The PADnet detects blockage in arteries and the quality of blood flow using pulse-volume recordings and segmental blood pressure measurements. Given appropriate signs and symptoms, a PADnet + Post-Exercise test may be necessary.
Before Your Test
Getting ready for your test requires little effort. You will be asked to remove clothing that covers your arms and legs, keeping your underwear on. You may be asked to remove your shoes and socks as well. A gown may be provided, or you may bring shorts to wear. This test often takes 15-20 minutes. Be sure to allow extra time to check-in.

• Do not smoke or use tobacco 30 minutes prior to your PADnet+ exam. Smoking constricts the peripheral arteries and can interfere with the results.
• If you think you cannot tolerate lying flat on the exam table, please let us know. 

During Your Test

You will lie down on the exam table. Pressure cuffs will be wrapped snugly around your arms, above your knees, calves, and ankles. The technician will inflate the cuffs, and the sensors in the machine will record the pulse waves that correspond to each beat of your heart.
Blood pressure will be recorded at your arms and ankles also. The ABI (Ankle-Brachial Index) is measured by the ratio between these pressures. P.A.D. is diagnosed if your ankle pressure is 99% or lower than your arm pressure. With severe narrowing, the ABI may be less than 50%.
You may be asked to perform toe-ups or to walk on a treadmill until symptoms are induced. After exercise, you will lie down on the exam table and repeat the arm and ankle tests.
If the ABI and/or waveforms are abnormal, your doctor may recommend additional diagnostic tests.
After Your Test
You may return to your normal routine right after the test. Your doctor will let you know when the results are ready.
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Am I At Risk For P.A.D.? Part 2

Answers to these questions will determine if you are at risk for Peripheral Arterial Disease (P.A.D.) and if a vascular exam will help us better assess your vascular health status.
1. Do you have foot, calf, buttock, hip, or thigh discomfort (aching, fatigue, tingling, cramping, or pain) when you walk which is relieved by rest?
2. Do you experience any pain at rest in your lower leg(s) or feet?
3. Do you experience foot or toe pain that disturbs your sleep?
4. Are your toes pale, discolored, or bluish?
5. Do you have skin wounds or ulcers on your feet or toes that are slow to heal?
6. Has your doctor ever told you that you have diminished or absent pedal (foot) pulses?
7. Have you suffered a severe injury to the leg(s) or feet?
8. Do you have an infection of the leg(s) or feet that may be gangrenous (black skin tissue)?
Next Time: A test that can detect P.A.D.
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Partying To Excess: Alcoholic Neuropathy

When we're young, we think nothing bad will ever happen to us. We drink to excess, never thinking of the potential ramifications of our partying lifestyle. Alcoholism is a serious condition and addiction which millions of Americans deal with every day.

Besides the liver problems alcoholics have, they also have problems with their feet. Alcoholic neuropathy is a nerve loss condition in the foot caused by the prolonged use of alcoholic beverages. Ethanol, the alcoholic component of these beverages, is toxic to nerve tissue. Over time, the nerves in the hands and feet can become damaged resulting in the same loss of sensation that is seen in diabetic peripheral neuropathy. The damage to these nerve is permanent. A person with this condition is at the same risk, and should take the same precautions as people with diabetic peripheral neuropathy. Another form of peripheral neuropathy is caused by exposure to toxins, such as pesticides and heavy metals, and is equally detrimental to health.
Symptoms for alcoholic neuropathy include a feeling of tingling, prickling, or needles and pins, general achiness or cramping, nausea, incontinence, or difficulty urinating.
Treatment for alcoholic neuropathy may include Vitamin B-12 injections, certain oral medications to ease any burning pain, topical ointments, magnetic therapy, and galvanic stimulation (which is the therapeutic use of electric current, particularly for stimulation of nerves and muscle.
If you have alcoholic neuropathy and currently do not see a podiatrist, call one of our six offices to make an appointment.
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What is Peripheral Arterial Disease? Part 1

Peripheral Arterial Disease (P.A.D.) is a serious circulatory problem in which the blood vessels that carry blood to your arms, legs, brain, or kidneys become clogged or narrowed. It affects 8 million Americans, most over the age of 50. It may result in leg discomfort with walking, poor healing or leg sores/ulcers, difficult to control blood pressure, or symptoms of stroke. People with P.A.D. are at significantly increased risk for stroke and heart attack.
Because only half of those who have P.A.D. actually experience symptoms, it is important that people with known risk factors be screened or tested for P.A.D.
The risk factors include:

• Being over age 50
• Smoking (currently or previously) 
• Diabetes
• High blood pressure
• High cholesterol
• Personal or family history of P.A.D., heart disease, heart attack, or stroke. 
• Sedentary lifestyle (infrequent or no exercise)

Signs and symptoms include:

• Pain in the legs brought on by walking and relieved by rest.
• Pain in the legs at rest due to poor circulation.
• Poorly healing wound on lower extremity.
• Injury to lower limb or foot involving blood vessels.
• Discoloration of toes and feet.

Simple foot deformities (hammertoes, bunions, bony prominences) or dermatologic conditions such as ingrown or thickened fungal toenails often become more serious concerns when P.A.D. is present. Because the feet and legs of someone with P.A.D. do not have normal blood flow- and because blood is necessary for healing- seemingly small problems such as cuts, blisters, or sores can result in serious complications.
Having both diabetes and P.A.D. further increases the potential for foot complications. People with diabetes often have neuropathy (nerve damage that can cause numbness in the feet), so they don't feel pain when foot problems occur. When neuropathy occurs in people with P.A.D., ulcers can develop over foot deformities and may never heal. For this reason, P.A.D. and diabetes are common causes of foot or leg amputations in the United States.
Once detected, P.A.D. may be corrected or at least improved. The foot and ankle surgeon can then correct the underlying foot deformity to prevent any future problems should the circulation become seriously restricted again.
Next Time: Questions to ask if you think you are at risk for P.A.D.
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How Do I Use Crutches?

Sizing Crutches
Even if you've already been fitted for crutches, make sure your crutch pads and handgrips are set at the proper distances, as follows:

• Crutch pad distance from armpits: The crutch pads (tops of crutches) should be 1 1/2" to 2" (about two finger widths) below the armpits, with the shoulders relaxed.
• Handgrips: Place it so your elbow is slightly bent- enough so that you can fully extend your elbow when you take a step. 
• Crutch length (top to bottom): The total crutch length should equal the distance from your armpit to about 6" in front of a shoe. 

Begin the Tripod Position
The tripod position is the position in which you stand when using crutches. It is also the position in which you begin walking. To get into the tripod position, place the crutch tips about 4" to 6" to the side and in front of each foot. Stand on your "good" foot (the one that is weight-bearing).
Walking With Crutches
If your foot and ankle surgeon has told you to avoid ALL weight-bearing, you will need sufficient upper body strength to support all your weight with just your arms and shoulders.

1. Begin in the tripod position, remembering to keep all your weight on your "good" (weight-bearing) foot.
2. Advance both crutches and the affected foot/leg.
3. Move the "good" weight-bearing foot/leg forward (beyond the crutches).
4. Advance both crutches, and then the affected foot/leg.
5. Repeat steps #3 and #4.
Managing Chairs With Crutches
To get into and out of a chair safely:
1. Make sure the chair is stable and will not roll or slide. It must have arms and back support.
2. Stand with the backs of your legs touching the front of the seat.
3. Place both crutches in one hand, grasping them by the handgrips.
4. Hold on to the crutches (on one side) and the chair arm (on the other side) for balance and stability while lowering yourself to a seated position, or raising yourself from the chair to stand up.
Managing Stairs Without Crutches
The safest way to go up and down stairs is to use your seat, not your crutches.
To go up stairs:
1. Seat yourself on a low step.
2. Move your crutches upstairs by one of these methods:

• If distance and reach allow, place the crutches at the top of the staircase.
• If this isn't possible, place crutches as far up the stairs as you can, and then move them to the top as you progress up the stairs. 

3. In the seated position, reach behind you with both arms.
4. Use your arms and weight-bearing foot/leg to lift yourself up one step.
5. Repeat this process one step at a time (Remember to move the crutches to the top of the staircase if you haven't already done so.).
To go down stairs:
1. Seat yourself on the top step.
2. Move your crutches downstairs by sliding them to the lowest possible point on the stairway. Then continue to move them down as you progress down the stairs.
3. In the seated position, reach behind you with both arms.
4. Use your arms and weight-bearing foot/leg to lift yourself down one step.
5. Repeat this process one step at a time (Remember to move the crutches to the bottom of the staircase if you haven't already done so.).
IMPORTANT! 
Follow These Rules for Safety and Comfort

• Don't look down. Look straight ahead as you normally do when you walk. 
• Don't use crutches if you feel dizzy or drowsy.
• Don't walk on slippery surfaces. Avoid snowy, icy, or rainy conditions.
• Don't put any weight on the affected foot if your doctor has so advised.
• Do make sure your crutches have rubber tips.
• Do wear well-fitting, low-heel shoes (or shoe).
• Do position the crutch hand grips correctly (See "Sizing Your Crutches).
• Do keep the crutch pads 1 1/2" to 2" below your armpits.
• Do call your foot and ankle surgeon if you have any questions or difficulties. 

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Kristen Stewart's First Hunt Injury

Kristen Stewart is not a fan of high heels to begin with and even wears ballet flats on the red carpet, but her casual look on the Tonight Show with Jay Leno on May 4th was due to a foot injury!

While reshooting scenes for Breaking Dawn Part 2, which hits theaters in November, Stewart got a puncture wound while filming. The wound happened while Stewart was working on her "first hunt" scenes, right after she is turned into a vampire. 

Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you've stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.

Puncture wounds are common in the foot, especially in warm weather (or on a hunt) when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop. 

Proper treatment within the first 24 hours is especially important with puncture wounds because they carry the danger of embedding the piercing object (foreign body) under the skin. Research shows that complications can be prevented if the patient seeks professional treatment right away. 

A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and seashells are some common ones. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty wounds because they involve penetration of an object that isn't sterile. Anything that remains in the wound increases your chance of developing other problems, either in the near future or later.

There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate it. The deeper the puncture, the more likely it is that complications such as infection will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you've stepped on something and the skin was penetrated, seek treatment as soon as possible.

The type and the "cleanliness" of the penetrating object also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance of infection.

Another thing that can determine wound severity is if you were wearing socks and shoes, particles of which can get trapped in the wound.

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications. 

Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better: within 24 hours after injury, if possible.

The surgeon will make sure the wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. Antibiotics may be prescribed if necessary.

Follow the foot and ankle surgeon's instructions for care of the wound to prevent complications.

Infection is a common complication of puncture wounds that can lead to serious consequences. Sometimes a minor skin infection evolves into a bone or joint injection, so you should be aware of signs to look for. A minor skin infection may develop in two to five days after injury. The signs of a minor infection that show up around the wound include soreness, redness, and possibly drainage, swelling, and warmth. You may also develop a fever. If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed.

Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound.

Although the complications of puncture wounds can be quite serious, early and proper treatment can play a crucial role in preventing them. 

What You Should Do:

• Seek treatment right away.
• Get a tetanus shot if needed (usually every ten years).
• See a foot and ankle surgeon within 24 hours.
• Follow your doctor's instructions:

1. Keep your dressing dry.
2. Keep weight off the injured foot.
3. Finish all your antibiotics (if prescribed).
4. Take your temperature regularly.
5. Watch for signs of infection (pain, redness, swelling, fever). Call your doctor if these signs appear. 

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Do I Have To Do That? Teen Foot Care 101

Keeping your feet healthy can help you avoid embarrassing and uncomfortable problems such as athlete's foot, foot odor, and toenail fungus. Follow these steps for healthy feet:
Wash your feet daily with soap and water. It's tempting just to swish your feet around in the shower but today's podiatrist says it's important to use soap to remove germs and grime. Don't forget to wash in between your toes!

Keep feet dry. Fungus, including the kind that causes athlete's foot, loves to grow in moist, damp environments, so after your shower dry your feet thoroughly, paying extra attention to the spaces between your toes. If your socks get wet during the day, change socks (It's not a bad idea to keep an extra pair in your locker or gym bag!).
Trim toenails on a slight curve. Too long toenails not only wreck your socks and look crazy, but they can harbor bacteria (eww!). Use a pair of toenail clippers to cut your toenails to just above or at the edge of your toe. Some docs will tell you to cut straight across, but a slight curve is ok too.
Wear supportive, properly fitted shoes. Improperly fitted, unsupportive shoes are a major cause of foot pain and injury. Don't worry- you don't have to wear granny shoes to get good support.

Secrets to Avoiding a Sandal Scandal

This summer's stylish sandals are definite attention grabbers, but will they force you to focus on the pain they are causing your feet? The American Podiatric Medical Association (APMA) has seven secrets to avoiding a sandal scandal this summer. Follow this podiatrist approved advice so you can enjoy the fun and sun with pain-free feet. Be sure to share these secrets, including the APMA accepted products, with family and friends!

1. Flats and Slides
Problem: arch and heel pain; inadequate cushioning and foot support.
Secret Solution: avoiding prolonged wearing; try cushioned inserts for shock absorption such as APMA accepted Foot Petals' Amazing Arches; select a sole that doesn't twist excessively. (Pictured are LifeStride Mateo Sandals)

2. Gladiator and Strappy Sandals
Problem: irritation between toes; callus and dead skin build-up around the heels; lack of support and shock absorption.
Secret Solution: select natural materials such as a soft, supple leather, ensure proper fit with no toes or heels hanging off the edge. (Pictured are Michael Antonio Dryden Sandals)

3. Platform and High Heels
Problem: pain in the ball of the foot and ankle injuries.
Secret Solution: wear lower, more stable heels (less than 2 inches in height); use an APMA accepted insert, such as Insolia. (Pictured are Miu-Miu Double Cross Platforms)

4. Wedge and Espadrille Sandals
Problem: ankle twist or sprain; instability and difficulty walking.
Secret Solution: try a wider, flatter wedge, rubber sole with good traction. (Pictured are Madden Girl Elivia Sandal)

5. Peep-toe Sandals
Problem: loads of pressure on the tootsies; bunions and hammertoes.
Secret Solution: wear only for short periods of time; insert Giovanna Toe Cushion by Heaven4Toes, an APMA accepted product. (Pictured are Kelly & Katie Quench Sandals)

6. Ankle Wrap Sandals
Problem: lack of adequate ankle support; friction causing blisters.
Secret Solution: try ankle wraps made of a soft, breathable material such as leather, cotton, or satin; ankle wrap not too tight; apply APMA accepted Strappy Strips by Foot Petals. (Pictured are Zigi Soho Carol Sandal)
7. Overall Persistent Pain
Secret Solution: See a podiatrist! Podiatrists are uniquely qualified to diagnose and treat conditions of the foot and ankle.

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May is Melanoma Awareness Month

You may be wondering why podiatrists would be writing about melanoma, but this deadly cancer affects your feet and ankles as well. Protecting and preventing melanoma on all parts of your body is crucial.
Melanoma is a cancer that begins in the cells of the skin that produce pigmentation (coloration). It is also called malignant melanoma because it spreads to other areas of the body as it grows beneath the surface of the skin. Unlike many other types of cancer, melanoma strikes people of all age groups, even the young.
Melanoma that occurs in the foot or ankle often goes unnoticed during its earliest stage, when it would be more easily treated. By the time melanoma of the foot or ankle is diagnosed, it frequently has progressed to an advanced rate, accounting for a high mortality rate. This makes it extremely important to follow prevention and early detection measures involving the feet as well as other parts of the body.
Most cases of melanoma are caused by too much exposure to ultraviolet (UV) rays from the sun or tanning beds. This exposure can include intense UV radiation obtained during shorter periods, or lower amounts of radiation obtained over longer periods.
Anyone can get melanoma, but some factors put a person at greater risk for developing this type of cancer. These include:

• Fair skin; skin that freckles; blond or red hair
• Blistering sunburns before the age of 18
• Numerous moles, especially if they appear at a young age. 

Melanoma can occur anywhere on the skin, even in areas of the body not exposed to the sun. Melanoma usually looks like a spot on the skin that is predominantly brown, black, or blue- although in some cases it can  be mostly red or even white. However, not all areas of discoloration on the skin are melanoma.
There are four signs- known as the ABCDs of melanoma- to look for when self-inspecting moles and other spots on the body:
A: Melanoma is usually asymmetric, which means one half is different in shape from the other half.
B: Border irregularity often indicates melanoma. The border- or edge- is typically ragged, notched, or blurred.
C: Melanoma is typically a mix of colors or hues, rather than a single, solid color.
D: Melanoma grows in diameter, whereas moles remain small. A spot that is larger than 5 millimeters (the size of a pencil eraser) is cause for concern.
If any of these signs are present on the foot, it is important to see a foot and ankle surgeon right away. It is also essential to see a surgeon if there is discoloration of any size underneath a toenail (unless the discoloration was caused by trauma, such as stubbing a toe or having something fall on it).
To diagnose melanoma, the foot and ankle surgeon will ask the patient a few questions. For example: Is the spot old or new? Have you noticed any changes in size or color? If so, how rapidly has this change occurred?
The surgeon will also examine the spot to determine whether a biopsy is necessary. If a biopsy is performed and it reveals melanoma, the surgeon will discuss a treatment plan.
Everyone should practice strategies that can help prevent melanoma- or at least aid in early detection, so that early treatment can be undertaken.
Precautions to avoid getting melanoma of the foot and ankle, as well as general precautions, include:

• Wear water shoes or shoes and socks- flip flops do not provide protection!
• Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of the feet. 
• Inspect all areas of the feet daily- including the soles, underneath toenails, and between the toes.
• If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails.
• Avoid UV radiation during the sun's peak hours (10am to 4pm), beginning at birth. While sun exposure is harmful at any age, it is especially damaging to children and adolescents.
• Wear sunglasses that block 100% of all UV rays- both UVA and UVB.
• Wear a wide brimmed hat.

Remember: Early detection is crucial with malignant melanoma. If you see any of the ABCD signs- or if you have discoloration beneath a toenail that is unrelated to trauma- be sure to visit a foot and ankle surgeon as soon as possible.
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