Thank you for explaining how smoking byproducts impact upon the skin and cells in the body. It helped me understand to a deeper level the affects of smoking on the body.
FYI, there is also a rare genetic condition called Olmstead Condition that causes such intense amount of pain since the nerves grow into the calluses. As a result, patients needed to be knocked out for any debrideing procedure. If you look for Olmstead Syndrome and calluses you will find several interviews with a young woman who needs to crawl on her knees to move around, until special skin grafts are attempted to minimize where the nerves can grow. There is another condition called pachyonychia congenital, but I believe that is a broader keratodermia than just an IPK. So, do you believe her smoking is causing her intense pain with these IPK?
Thank you, I recall watching the episode where the young lady had the calluses removed under general anaesthesia, followed by skin grafting. I would say most of the very painful IPKs that I have seen, the patients are heavy smokers. Speaking with colleagues, they have also noticed this.
@@DrOzanAmir thank you for your quick reply to my questions, complete with typos. I went back and corrected them. Sometimes, my IPAD keyboard can’t keep up with my typing and autocorrect challenges a number of words on me. I understand Olmstead is very rare and it was fascinating to see the nerves growing into her calluses once they were able to anesthetize her. So far, the skin graft seems to be helping her. Dr. You, a podiatrist in London, doesn’t think they would allow her to do a skin graft in a similar case. I am not sure where you practice, but I would love to know about procedures such as skin grafts that aren’t OK in every country and how countries can vary in handling a variety of conditions by developing their own cutting edge techniques. Do you have a lot of PPK or PC (pachyonychia congenital) patients? I am also curious about how you treat patients with icthyosis or severe plaque psoriasis on their feet. Both conditions seem beyond just urea cream.
@@Familylawgroup I didn't pay any attention to the typos:) I am based in Australia. I have not performed skin grafts for this condition, mainly because I am not aware of the outcomes. I specialise in reconstructive foot surgery and see very few of these skin and nail conditions. When I was a general podiatrist, I use to see them more often especially icthyosis or severe plaque psoriasis. It involves a lot of time and care debriding away the hardened skin and sanding it down. The person would need to come in regularly to have this performed.
I don't really understand why smoking is being highlighted as if its the primary cause of her problem here. I appreciate that the focus of the video isn't about the anatomical and bio-mechanical issues the patient had but I think its important to point out that HD is actually caused by these pressures. Looking at her skin integrity, color etc at this stage, she doesn't really strike as having significant peripheral vascular disease either - her issues are likely pressure related (bony prominence would be my bet) combined with poor footwear +/- neglect /lack of appropriate/timely access to care.
Hi, You're correct, the primary problem is related to pressure under the met heads. All practitioners would accept this. The heloma durum, that are highly sensitive (far more painful than they should be), I've noticed appear in chronic smokers. This is the reason I focused on smoking.
Carbon monoxide binds to hemoglobin in a way that is stronger than oxygen, forming carboxyhemoglobin. This reduces the oxygen-carrying capacity of blood, leading to hypoxia. However Dr Ozan May have eliminated the fact that there is no direct link between carbon monoxide and intractable plantar keratoderma; they involve different biological processes. Intractable plantar keratoderma is typically associated with genetic factors and abnormal skin cell proliferation.
@@IanReillyPodsurgeon lets not confuse correlation with causality. Yes smoking impacts the quality of skin, vascular state- healing and various other things, but its not the primary cause of HD development. pressure and friction are the main culprits. Theres surely a bony prominence there where the HD is forming - just looking at her feet alone we can see theres something not right with her MPJs and midfoot.
@@zineguri8515 im not doing! But you miss THE MAIN cause of these buggers. Latest research shows the start out as VPS - yes at the site of the great point of pressure so biomechX and anatomy at play morphing these VPs into corns - and nicotine makes them worse.
