Toe Bro: Painful, right?
Patient's Companion: It is. Like, every time she's walking, she feels a lot of pain.
TB: Yes. And you tried cream, it didn't work.
PC: No.
TB: And so, to me, even though it looks like a cracked heel, the way the edges are so bumpy, I think it might be a wart.
But if I scrape down all the dead skin and it's flat, there's no real bleeding, no black dots,
we just have to put a lot of moisturizer or cream and a sock and it'll close up, okay?
PC: And then we have to, like, come back for another visit for that if it's just a scab?
TB: Yes, we come back usually a month and a half-two months--
PC: To make sure.
TB: --clean it up again because what happens - the skin has cracked.
PC: Mhm-hm.
TB: I need to clean off the dead skin so the edges can come back together
and that's why we need to come back so I can clean everything up.
PC: It takes some time.
TB: It takes some time, yes.
So--
Patient: [speaking in Urdu]
PC: Yeah, she uses, like, a scrub for when she's taking showers [inaudible] dead skin.
TB: Yes.
PC: She uses scrub on top of it. TB: But--
P: [inaudible]
TB: But sometimes when it get so thick, it's too hard for people to remove.
PC: Yeah, yeah.
TB: So that's why--
PC: But is it a good idea to do it?
TB: It is. it is.
If it's just dead skin. P: [speaking in Urdu]
TB: If it's a wart, it's no good because we could be spreading it and that's why I'm curious to see what it is.
If it's too sensitive, you let me know.
PC: [speaking in Urdu]
TB: Okay?
P: [speaking in Urdu] TB: So just-- I'm just removing a little a bit at a time.
Let her know if it's too sensitive, let me know.
PC: Okay. TB: Okay?
PC: [speaking in Urdu]
TB: You okay?
P: Okay.
TB: So your doctor referred to you here?
PC: Yes.
TB: Very good.
PC: She's [inaudible] downstairs in the [inaudible].
TB: Yes, okay.
P: [speaking in Urdu]
PC: And that she hurt her [inaudible] so her doctor--
TB: Is downstairs? PC: [inaudible] she sent her to the hospital,
she recommended her as well over here.
TB: Oh, okay. That's good.
So the one side
was relatively--
is relatively flat, no black dots
which is good.
PC: Let's see the left side-- or the right one.
TB: Yes, so this side has a few
black dots but sometimes, if there's too much pressure on skin, we can get pin point bleeding
and that's not true warty tissue.
So I'm gonna use my-- P: [winces in pain]
TB: Oh, sorry, sorry.
Very good, you let me know. [laughs]
If it's-- I'm gonna use that little magnifying glass to see if I can
see anything but, to me, it actually looks pretty good.
PC: Just dead skin.
TB: Just dead skin.
I know this one's sensitive, you okay?
Okay, I'm sorry about that.
Sensitive?
P: Yeah... TB: Sensitive? Okay.
Just this lit-- little part left.
Very good.
No pain here?
P: No.
PC: Wow, you just cleaned up. TB: [laughs]
PC: It looks a lot better now.
TB: It looks a lot better.
So the important part is me just
cleaning these edges
where the crack is.
That way, the normal skin is fresh, the edges are fresh and can reconnect.
PC: So the dead skin can heal up on it's own.
TB: Yes.
PC: It's just the pressure, right? That splits it apart.
TB: Exactly, and that the skin is too dry.
PC: Hm...
TB: So she needs to be wearing shoes that are softer.
PC: Okay. [speaking in Urdu]
P: Softer? Yeah, I see.
TB: Very soft.
PC: Canvas shoes [inaudible]? Like, uh--
TB: No, must be foam.
PC: Yeah, that's what I'm saying. She has this, uh, canvas shoes that she wears sometimes.
TB: Canvas is no good. It should be foam or gel.
P: [speaking in Urdu]
PC: [speaking in Urdu] P: [speaking in Urdu]
PC: Walking shoes is good, she's wearing walking shoes--
P: Dr. Scholl's. PC: --or Dr. Scholl's.
Dr. Scholl's is good-- shoes.
[inaudible]
TB: Okay.
So I'm just gonna take a quick look with the--
PC: With the glass.
TB: --yeah, with the magnifying glass.
This is a really tricky one.
There's a lot of black dots in this area.
P: [speaking in Urdu]
TB: You see all this?
PC: Yeah.
TB: Normally though when I scrape a wart,
it bleeds very easily. It's not bleeding.
And sometimes in an area of high pressure,
we get little pinpoint bleeding because there's, like, bruising happening because of all the pressure.
So I still--
we're still gonna treat it like a cracked skin.
PC: Okay.
TB: I don't see enough signs to really think that it's a wart.
That's why it's very important we come back in a month and a half to see how everything's healing up, okay?
I'm gonna file it down a little bit more and then I'm gonna put some special cream on it, okay?
To help-- to moisturize it. So see all this here?
It's not really bleeding
and normally a wart, when we scrape it, bleeds very easily
but the skin sometimes does bruise when there's too much pressure on an area,
so that's why we might have those little black dots.
PC: Huh, could be.
TB: It could be. It might not have to do anything with a wart, it could just be the amount of pressure but it's not bleeding.
PC: And bleeding is the only thing that tells us that it's a wart?
TB: One of the-- one of the signs,
beside the little black dots.
So you can see the cracks pretty much gone.
You can see it looks more healed.
PC: Yeah, that's what I'm saying, like, the crack isn't all the way deep in there but it's just--
TB: And that's why sometimes it could be a wart, that's why we really need to see how it's looking.
P: [speaking in Urdu]
PC: Can she use that scrub while she's--
TB: I would use something disposable from the Dollar Store, like, an emery board, you know, like, a nail file?
PC: Yeah.
TB: Something that she can use and then throw away because, if this is a wart, she could be spreading it
so I want to stay safe for now for the next month and a half.
PC: Okay. Okay, at least for another month and a half, huh?
TB: What I'm using - this one here. This is a German foot product, it's a foot foam, not a cream.
It does two things: one - it builds a barrier over the skin protecting the skin from outside enviro-- uh,
outside things and it builds a barrier to keep the body's own moisture inside, okay? So it build a barrier
to keep all the body's moisture inside.
The second thing it has - it has fat cells to help repair the skin tissue.
This is a lot more high-tech than just normal foot lotion or foot cream
and this can help rebuild cracked skin.
PC: Okay.
TB: This is something that you can't buy in stores but you can buy from-- from medical offices and I sell this here.
Cream is better than lotion; cream is thicker and builds a better barrier than lotion, lotion's too watery.
So if you're going to use something at home, you can-- you should be using any sort of cream.
PC: She does have a cream that was, like, that said, uhm, you know, "crack cream".
She uses-- she actively [inaudible].
TB: Yep, so she can use that.
This is something that's a little bit, you know, it could be
a little bit on the higher end - it's $30 for a can.
P: [speaking in Urdu]
TB: And the can will last you probably around
two months if you're using it everyday, just-- especially in this area.
But it's really important that we try to keep this as moisturized as we can for the next month and a half till we come in.
That way,
when you come back in, I'll scrape down some of the dead skin that will build up and those black dots should go away.
We shouldn't see any more black dots because there should be no more pressure.
P: [speaking in Urdu]
TB: Right? And there'll be no buildup pf hard skin causing the-- the pressure and the bruising.
If it's a wart, it'll probably still be there
and we might get a big buildup again.
But you see how flat it is?
PC: Yeah.
TB: This should be good.
PC: It's not being for now, but it could start later on.
P: [inaudible] pain, pain.
TB: A little bit right now? Yeah.
PC: It's like a pain--[inaudible].
TB: But to me it looks pretty good. I think it might've just been a crack.
PC: Yeah, that's probably.
TB: Yeah, so she needs-- see these shoes? She needs something that's softer.
Softer all the time.
P: [speaking in Urdu] PC: [speaking in Urdu]
Yeah, she's just wearing it right now.
TB: Of course, of course.
So we come back in a month and a half. Cream all the time, every night, she's putting on cream
to really moisturize this area. She wears a nice thick soft
slipper at home and when you're out and about, you're wearing a running shoe or something that's very
soft and thick. PC: Yeah, very soft, like,
[speaking in Urdu]
TB: And she's gonna use a disposable file or emery board, like, you know what women use for their nails?
PC: Yeah.
TB: On this, just to make sure that there's no contamination just for now until we know that it's just--
PC: [speaking in Urdu]
TB: We basically come back in a month and a half, I clean it up one more time and then I'll let you know if it was really just cracked skin or it was a wart.
And then we should be good.
PC: We'll be back after a month and a half.
TB: Yeah, and then-- if it's just cracked skin, she just has to maintain it by regular filing,
okay?
PC: Alright.