Lam, Timothy G, DPM

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Fax: (518) 370-7162

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Lam, Mindy

Lam Mindy DPM

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http://lamfamilyfootcare.com

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Physicians & Surgeons, Podiatrists, Physicians & Surgeons, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Sports Medicine, Physicians & Surgeons, Surgery-General, Sports Medicine & Injuries Treatment

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Phone: (518) 370-3668

Address: 1610 Union St, Schenectady, NY 12309

Website: http://lamfamilyfootcare.com

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Lam, Timothy G, DPM

General Practitioners

Warts
Arthritis
Plantar Fasciitis
Treatment of plantar fasciitis is similar to that for heel pain. Cortisone injections may be used for the treatment of plantar fascitits. The main emphasis of treatment is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching,night splints, over the counter arch supports, and orthotics.
Primary Care
We spend quality time with each patient in order to better understand your foot care needs, and to recommend the best course of treatment. We work closely with primary care physicians and other specialists to ensure the most effective treatment plan.
Diabetic Foot Care

Carpal Tunnel Syndrome
Historically, researchers performing cryosurgery observed that extreme freezing had an anesthetic effect beyond the temporary relief produced by simple cooling. Over the last thirty years, many modalities have been introduced to address chronic pain by surgeons, pain management specialists, and neurosurgeons. These techniques have had a common goal of producing prolonged nerve blocks to relieve intractable pain. Within the last ten years, cryosurgery has been utilized to relieve trigeminal nerve pain, lumbosacral pain and most recently carpal tunnel syndrome.

Depression

Endocrinologist

Diabetes Care

Ultrasound
Ultrasound diagnostic technology has been applied to the diagnosis of a variety of disorders affecting foot and ankle. Ultrasound images are typically used to help diagnose...
MRI
Initial diagnosis is made by a careful history and physical examination. Pain localized to the bottom of the great toe joint is the typically presentation of these types of injury. The pain can be easily localized to either the tibial or fibular sesamoid by directly pressing on either bone. Movement of the joint may also duplicate the patient's pain. Occasionally, swelling and redness may also be seen depending on the mechanism of injury. X-rays are often obtained to differentiate sesamoiditis from a sesamoid fracture. Three different views of the sesamoids are commonly taken. Also, when sesamoid fractures are suspected, it is helpful to x-ray the uninvolved foot as well. Typically, the sesamoid bones are 2 well-defined bones on x-ray. This is the case for approximately 85% of the population. However, in 15% of patients each sesamoid bone may consist of 2 or more fragments (referred to as multipartite or several pieces). This will often make the distinction between normal and fracture difficult. In this case, a bone scan or MRI can be helpful. It is important to differentiate between sesamoiditis versus fracture since the treatment is dramatically different.
X-Rays
Computed Tomography
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient's complaint. Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up in the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist will be able to actually feel the neuroma on his exam of the foot. Special studies such as MRI, CT Scan, and nerve conduction studies have little value in the diagnosis of a neuroma. Additionally, these studies can be very expensive and generally the results do not alter the doctor's treatment plan. If the doctor on his exam cannot feel the neuroma, and if the patient's symptoms are not what is commonly seen, then nerve compression at another level should be suspected. In this instance, one area to be examined is the ankle.

Wound Care
Ankle Surgery
Joint Replacement
If the condition progresses to the point of spurring around the joint, surgery may be indicated. Depending upon the degree of degeneration of the joint, surgery may consist of simply removing the bone spurs around the joint or may require a total joint replacement ( See surgery of Hallux limitus ). Following surgery, the use of a functional orthotic is useful to improve the joint function.
Bunions
One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes, or with physical activity, such as walking or running. Bunions are most commonly treated by conservative means. This may involve shoe gear modification, padding and orthoses. When this fails to provide adequate relief, surgery is often recommended. There are several surgical procedures to correct bunions. Selection of the most appropriate procedure for each patient requires knowledge of the level of deformity, review of the x-rays and an open discussion of the goals of the surgical procedure. Almost all surgical procedures require cutting and repositioning the first metatarsal. In the case of mild to moderate bunion deformities the bone cut is most often performed at the neck of the metatarsal (near the joint).
Gangrene
Ingrown toenails are due to the penetration of the edges of the nail plate into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. With bacterial invasion, the nail margin becomes red and swollen often demonstrating drainage or pus. In people who have diabetes or poor circulation, this relatively minor problem can be become quite severe. In this instance, a simple ingrown toenail can result in gangrene of the toe. Patients with joint replacements or pace makers are at risk of bacterial spread through the blood stream resulting in the spread of infection to these sites. These patients should seek medical attention at the earliest sign of an ingrown toenail. There are several causes of ingrown toenails: a hereditary tendency to form ingrown toenails, improperly cutting the toenails either too short or cutting into the side of the nail, and ill-fitting shoes can cause them. Children will often develop ingrown toenails as a result of pealing or tearing their toenails off instead of trimming them with a nail clipper. Once an ingrown toenail starts, they will often reoccur. Many people perform "bathroom" surgery to cut the nail margin out only to have it reoccur months later as the nail grows out.
Ingrown Toenails
Treatment for ingrown toenails is relatively painless. The injection to numb the toe may hurt some, but a skilled doctor has techniques to minimize this discomfort. Once the toe is numb, the nail margin is removed and the nail root in this area is destroyed. Most commonly, the doctor will use an acid to kill the root of the nail, but other techniques are also available. It may take a few weeks for the nail margin to completely heal, but there are generally no restrictions in activity, bathing, or wearing shoes. Once the numbness wears off, there may be some very mild discomfort but rarely does this require pain medicine. A resumption of sports activities and exercise is generally permitted the following day.

Corns
Symptomatic treatment of hammertoes consists of such things as open toed shoes or hammertoe pads. There are over the counter corn removers for temporally reducing the painful callus often seen with the hammertoe. These medications must be used with caution. They are a mild acid that burns the callous off. These medications should never be used for corns or calluses between the toes. Persons with diabetes or bad circulation should never use these products.
Ulcer
Calluses
Hammertoes are a contracture of the toes as a result of a muscle imbalance between the tendons on the top and the tendons on the bottom of the toe. They can be flexible or rigid in nature. When they are rigid, it is not possible to straighten the toe out by manipulating it. Frequently, they develop corns on the top of the toe as a result of rubbing on the shoe. They may also cause a bothersome callus on the ball of the foot. This occurs as a result of the toe pressing downward on the bone behind the toe. This area then becomes prominent and the pressure of the bone against the ground causes a callus to form. (Corns and Calluses)
Fungus
The most common cause of yellowed, thick and /or deformed toenails is a fungal infection of the toenail. The fungus that infects the nail, most commonly, is the same fungus that causes athletes foot. It tends to be slowly progressive, damaging the nail to a greater and greater degree over time. The infection usually starts at the tip of the nail and works its way back. It usually is not painful and often not noticed until it has gotten well established. A single toenail or any number of nails can be affected. It can also occur on just one foot. Over time, the nail becomes thickened, crumbly, and distorted in appearance. Sweaty feet contribute to the initial infection process and contribute to its spread. The fungus prefers an environment that is moist, dark, and warm, which is why it affects the toenails much more often than fingernails. It does not spread through the blood stream. The infection limits itself to the nails and skin. It is often found in association with areas of dry scaly skin on the bottom of the foot or between the toes. The dry scaling skin is frequently found to be chronic athletes' foot. It is not highly contagious, and family members are almost as likely to contract it from some other source as they are from the family member who has the infection. Keeping common showering areas clean is recommended, and sharing shoes should be avoided.
Lesions
Athlete's foot is caused by a fungal infection of the skin on the foot. The majority of these infections are caused by one of three fungal agents called dermatophytes. Athlete's foot is by far the most common fungal infection of the skin. The infection can be either acute or chronic. The recurrent form of the disease is often associated with fungal-infected toenails. The acute form of the infection most often presents with moist, scaling between the toes with occasional small blisters and/or fissures. As the blistering breaks, the infection spreads and can involve large areas of the skin on the foot. The burning and itching that accompany the blisters may cause great discomfort that can be relieved by opening and draining the blisters or applying cool water compresses. The infection can also occur as isolated circular lesions on the bottom or top of the foot. As the skin breaks down from the fungal infection, a secondary bacterial infection can ensue.
Psoriasis
Not all thicken or yellowed toenails are caused by a fungal infection. Injury to a toenail can cause the toenail to grow in a thickened or malformed fashion. This can be due to an established fungal infection or may be due to the damage caused to the nail root when it was injured. In these instances, treatment with anti-fungal medications will not correct the malformed nail. Other causes of thickened toenails are small bone spurs that can form under the toenail and psoriasis. Taking a scraping of the toenail and culturing it makes the diagnosis.
Burns

Physical Therapists

Sports Medicine
Physical Therapy
The treatment of sesamoid injuries is dependent on making a definitive diagnosis. Because sesamoiditis is an inflammatory condition, treatment directed at reducing inflammation is often helpful. This may include: rest, ice, anti-inflammatory medications and physical therapy. More resistant cases of sesamoiditis may be helped by clf muslce stretching, a cam-walker removable cast and/or an occasional cortisone injection. Cortisone injections should only be performed after the physician is fairly certain a fracture does not exist.
Flatfoot Correction
Heel Pain
Ankle Sprain
Orthotics and Prosthetic Therapy

General Podiatry
We welcome you as a patient to our podiatry practice in Upstate New York. We are grateful that you have chosen us as the health care provider for your feet. Our staff is committed to providing the finest podiatric care in a warm and friendly environment in order to make you feel relaxed and comfortable.
Achilles Tendonitis
The most common form of injury to the Achilles tendon is called Achilles tendonitis, which is an inflammatory condition causing pain in the Achilles tendon. Achilles tendonitis generally occurs in people who are active in sports activities. Types of sports that commonly are associated with Achilles tendonitis are basketball, tennis, running, football, soccer, volleyball and other running and jumping sports.
Ankle Sprain
Bunions Problems
The classic bunion, medically known as hallux abductovalgus or HAV, is a bump on the side of the great toe joint. This bump represents an actual deviation of the 1st metatarsal and often an overgrowth of bone on the metatarsal head. In addition, there is also deviation of the great toe toward the second toe. In severe cases, the great toe can either lie above or below the second toe. Shoes are often blamed for creating these problems. This, however, is inaccurate. It has been noted that primitive tribes where going barefoot is the norm will also develop bunions. Bunions develop from abnormal foot structure and mechanics (e.g. excessive pronation ), which place an undue load on the 1st metatarsal. This leads to stretching of supporting soft tissue structures such as joint capsules and ligaments with the end result being gradual deviation of the 1st metatarsal. As the deformity increases, there is an abnormal pull of certain tendons, which leads to the drifting of the great toe toward the 2nd toe. At this stage, there is also adaptation of the joint itself that occurs.
Calluses
Diabetic Foot Care
Flat Feet
Hammertoes
They tend to slowly get worse with time and frequently flexible deformities become rigid. Treatment can be preventative, symptomatic or curative. (For information on hammertoe of the big toe see Hallux hammertoe)
Heel Spurs
To understand the cause of the pain one must understand the anatomy of the foot and some basic mechanics in the function of the foot. A thick ligament, called the plantar fascia, is attached into the bottom of the heel and fans out into the ball of the foot, attaching into the base of the toes. The plantar fascia is made of dense, fibrous connective tissue that will stretch very little. It acts something like a shock absorber. As the foot impacts the ground with each step, it flattens out lengthening the foot. This action pulls on the plantar fascia, which stretches slightly. When the heel comes off the ground the tension on the ligament is released. Anything that causes the foot to flatten excessively will cause the plantar fascia to stretch greater than it is accustom to doing. One consequence of this is the development of small tears where the ligament attaches into the heel bone. When these small tears occur, a very small amount of bleeding occurs and the tension of the plantar fascia on the heel bone produces a spur on the bottom of the heel to form. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone. Heel spur formation is secondary to the excessive pull of the plantar fascia where it attaches to the heel bone. Many people have heel spurs at the attachment of the plantar fascia with out having any symptoms or pain. There are some less common causes of heel pain but they are relatively uncommon.
Heel Pain
Ingrown Toenails
There are very few complications associated with this procedure. Reoccurrence of the ingrown toenail can occur a small percentage of the time. Continuation of the infection is possible which can be controlled easily with oral antibiotics. On occasion, the remaining nail may become loose from the nail bed and fall off. A new nail will grow out to replace it over several months. With removal of the nail margin, the nail will be narrower and this should be expected.
Foot Neuroma
A neuroma is the swelling of nerve that is a result of a compression or trauma. They are often described as nerve tumors. However, they are not in the purest sense a tumor. They are a swelling within the nerve that may result in permanent nerve damage. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning pain, tingling, and numbness in one or two of the toes is a common symptom. Sometimes this pain can become so severe, it can bring tears to a patient's eyes. Removing the shoe and rubbing the ball of the foot helps to ease the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
Foot Orthotics
Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the- counter arch supports or heel cushions may be beneficial. The next phase of treatment might consist of continued calf muscle stretching exercises,a night splint, cortisone injections and orthopedic taping of the foot to support the arch. If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain and abnormal pronation of the foot. Surgery to correct heel pain is generally only recommended if orthotic treatment has failed. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment. Following surgical treatment to correct heel pain the patient will generally have to continue the use of orthotics. The surgery does not correct the cause of the heel pain. The surgery will eliminate the pain but the process that caused the pain will continue without the use of orthotics. If orthotics have been prescribed prior to surgery they generally do not have to be remade.
Plantar Fasciitis
Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot called the plantar fascia. The plantar fascia attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain. In severe instances the ligament can rupture resulting in immediate severe pain. If the ligament ruptures the pain is so great that the patient can not place weight on the foot. Should this happen, the foot should be elevated and an ice pack applied. An appointment with your foot doctor should be made at your earliest convenience. Sports such as tennis, racket ball, and aerobics can cause extreme tension on the plantar fascia resulting in small tears or rupture of the ligament. However, other less stressful activities can result in tears or rupture of the plantar fascia under the right set of circumstances. (For a more through discussion of the cause of plantar fasciitis see heel pain ) One consequence of small tears in the plantar fascia is the formation of firm nodules within the plantar fascia, called fibromas.
Podiatric Deformities
Long-term therapy must be geared to identifying the cause of the sesamoiditis so as to avoid these situations or to accommodate foot deformities or modify shoes. This may include the use of orthotic devices, calf muscle stretching, or a dorsal night splint. This may also include the limited use of high heel shoes.
Podiatric Surgery

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