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What's up guys? How are my toes doing out there? This is Jonathan a.k.a.
The Toe Bro, and I am back for another video.
It's been a long time since my last video, so I really apologize for that guys. It's been a pretty busy month.
I was doing a little bit of traveling, some for business some for pleasure, but I'm back and I'm here to give you guys
something, new something exciting,
another surgical procedure.
Before we get started with the surgical procedure,
I just want to say thank you for all the support, all the love, all the likes, all the comments, all the
dislikes, all the criticism. I'll take it all. I'll take everything I can get from you guys.
I tried my best this week to respond to as many comments as I could and give you guys as much info.
The support and and the interaction have been amazing!
I can't believe how much these videos are growing and it really motivates me this month to put a lot more content out.
So I'm trying to work on scheduling more content on a more regular basis.
I have like 40 or 50 videos I filmed over the last month two months of all these different procedures, surgical procedures,
routine care, thick nails, corns, calluses, whatever I've been doing in my office,
I've been trying to film it. So it's now just a matter of me sitting down,
editing them and making them really presentable, informative, and fun for you guys. So based on the feedback from you guys
I'm going to do something a little bit different with this video. I'm just going to go right into it no music,
talk everything out, explain what's going on.
Keep it simple.
Let you guys be able to hear me clearly and then we'll see how you guys like this one and from that we'll decide what
the next video is going to be like.
We have a really exciting interesting case today.
So let's go into a little bit of a background information on the patient. So we have a
young mother of three. She's early forties, all her children have seen me.
She had great results with her children with the issues that they had some
foot pain, some some plantar warts; everything's gone. So she saw me starting to complain of
some pain herself in her right fist baby toe. So in the first appointment,
we take a look at her foot and we could see this yellow hard
circular lesion on the inside of a right, baby toe. So from first glance,
it looks pretty much to be like a corn and a corn is usually hard skin with a little
central core portion that's caused because of too much pressure from the baby toe
touching the other toe and this is usually caused because of tight or narrow footwear. So our patient today, she
loves wearing high heels, loves wearing pointy shoes. So from the background
information and just from first glance, it really does look to be a core to be a corn. So
how we normally treat corns is we remove as much of the dead skin, we try to
nucleate or
core or take out the core from this yellow hardened portion, and that's what's going to give the patient relief.
So during that first treatment, as I was removing the core, I found that it was extremely soft and
it wasn't a perfect circle, and it was very fleshy and
normally a corn is pretty firm and just hard dead skin.
So even though it's between the toes and there's a lot of moisture, when I'm usually taking out a corn,
it is a hard core of dead skin. So when I noticed that it was a little bit fleshy and soft,
not like a typical corn, a few flags went off in my head,
and I said you know
how long have you had this and it was just a recent time she said you know just a month or so
and
she's been wearing high heels for a long time. So again,
something that just popped up I asked her if there was any new shoes any a new activity? Nothing changed.
I'm very honest with my patients so and I'm very open and I
speak out loud to them, so I told her right away
I have a feeling this may not be just a normal corn and she asked what could it be I said,
You know I have a feeling it could possibly be a wart and
she says, you know my kids had warts.
I've seen warts before. Don't they have tons of little black dots? Don't they look a little bit different?
And I said, they do
but because of the
location, you know the fact that just popped up, the way that a fleshiness of the of the lesion that I just took out, I
said, it doesn't seem like a normal corn. So this is the game plan; we're going to try to treat it like a corn,
we're going to try to avoid tight pointy shoes, we're going to add a spacer in between,
I'm going to see how it grows back or how it feels with time..
If it comes back very quickly with a lot of pain
and if it still has fleshy look to it,
even though you're wearing better footwear,
I feel that it may be a wart and we might have to
surgically remove it. So sure enough after a week or so I get another call,
the office get the call from her saying, you know the pain is back, the lesion, has fully filled up
so even though we removed quite a bit amount of a dead skin,
she says that it filled up, its flat again, and it's very very painful.
Even when I do normal corns, when we remove the corn, there should be relief for at least a few weeks,
more than just one week.
So I told her you know what I think that's a sign that we might have to do a surgery to surgically remove
this lesion and
possibly get rid of this wart that might be here okay? Because it's not normal for a corn to react like that.
We booked an appointment where she knew ahead of time that we're going to do the procedure.
So what would happen with any sort of excision for this kind of lesion, the toe would be numb.
She doesn't feel anything from the procedure.
She's able to drive home
and she's just ready for a little bit of discomfort
possibly for the first couple days and for the toe to be a little bit sore for the first week. So we booked an appointment
knowing what was about to happen and let's continue with the video seeing how the whole procedure works from start to finish.
So here we are guys.
We're in office about to do the procedure. So the first thing we got to do is
freeze this baby toe. So a little background information on on how to freeze a toe. So actually each toe
has four nerves; two on the top two on the bottom. So what we're going to be doing is injecting
from the top of the toe
to freeze the top nerve
and
what will happen, after we freeze the top nerve, I push the needle a little bit deeper to reach the bottom nerve on that same side.
So it's a completely numb toe. We have to do two injections on either side of the toe.
We drop freezing on the top portion and on the bottom portion on that one side and this will completely
numb the toe and there will be no pain or any sensation during any sort of procedure. So what I'm using is a mixture of
anesthetic,
short-acting anesthetic that kicks in very fast with a mixture of a long-acting anesthetic.
So this is something that will allow the toe to stay numb for up to 10 to 12 hours.
So the reason I use this kind of mixture is
to allow the patient to have very little to no discomfort after the procedure. So as you can see, it's very quick, very simple,
the toe is numb.
After the injection is complete, and I've tested the toe make sure it's completely numb, I will prep all my instruments,
get everything ready and off we go.
So what I'm putting on right now is a tourniquet and this tourniquet is very important anytime
I do any sort of surgical excision or removal of a potential growth. The reason for that,
we want to minimize the amount of blood loss during the procedure
and I also want to have a very clear vision of the field that I'm working on. Anytime
a lesion is bleeding too much,
it's very hard to see the area that you're working on to make sure that you've removed any sort of bad or
unwanted growth. So by having this little bit of a tourniquet on the toe, it's going to accomplish
all those things, little to no blood loss, and I can see the area I'm working in very clearly.
The tourniquet is on, it's secure. I'm just wiping down the toe with an antibacterial
disinfectant. Now, it's time for the fun part. So what that is is starting to prepare the area for the removal of this
mass. So the way I do that is by using a scalpel blade
and I lightly score an area around the lesion and I leave around two or three millimeters of healthy skin
just outside that bad circle to make sure we get everything else. So what I'm doing right
now is lightly scoring the skin just to create a little bit of an incision where I can use a curette
to pull out this lesion.
I'm not going deep. The problem is if you go too deep, you might cut into deeper tissue and
create more of a scar or wound than we really need to. If this is a wart, which I really do think it is,
we just have to pull off the wart from the bottom layer of the skin.
So right now I'm taking out the curette,
I'm putting it in a little groove that I made, I'm starting to pull the wart off of what we call the basement membrane.
The moment I started to lift the lesion, I was
100% confident that it was truly a wart and the reason for that a wart, when we excited or cut it out, it's an
encapsulated mass. So as you can see, it's basically a lump of very hard firm skin.
This comes usually off in one piece with good technique.
I literally just have to scrape or pull the wart off the basement membrane
and it should come off in one piece. The reason that there's a little bit of blood
that's because a wart is full of vascular tissue. A wart is a virus and uses the body's blood supply to grow and multiply.
So it's normal, even with a tourniquet, to have a little bit of bleeding
but as you can see, there's no steady blood flow. Once I get that mass out,
there's very little to no blood. So what I'm doing now is I'm cleaning the area
removing as much of that warty tissue that was attached to this area
from the healthy skin and you can see how important it is to have a good tourniquet.
This is what's going to allow me to see that all that's left behind is normal tissue.
The basement membrane is a nice
thin layer of white tissue,
very very smooth and so I
can see that I'm on the basement membrane. I'm pulling off all the dead warty tissue
that's around the area making sure that there's nothing left behind. We want to stay above this layer of skin.
Underneath this layer, that's where all the fat cells are, that's where the muscle, and
deeper structures can be found. Once we go past that level, that's where we can definitely increase our chance of having a
scar or further damage to
structures that don't need to be affected.
So at this point, I've continued to clean out the area. I feel pretty confident that there's nothing left behind.
Looking much healthier. There's no blood. So once I'm confident that everything is out, there's no more potential warted tissue,
I'm going to apply two things to make sure that this wart tissue doesn't grow back.
Number one is electric cautery and I'm using a disposable
electric rotary tool that will
add a controlled temperature burn or damage that tissue
ensuring that any wart tissue left behind is killed and after that
I'm going to be applying that chemical called phenol, and this is the same chemical I use
during my nail surgeries to prevent any nail from growing back and the reason I use these two steps is really to try to
eliminate the chance of a regrowth.
Even when performing a surgery like this,
it's possible for the wart to grow back, so the more aggressive
I am now with removing as much tissue as I can and then applying
electricity and an acid will help increase our chance of the warts never coming back.
The wart has been removed.
I don't see any warty tissue left behind.
I used electrocautery, I use a chemical cautery to try to kill any remaining war tissue so all that's left
now is just a dress the wound. So again, I'm using
betadine or colored Iodine which is an antibacterial
ointment that will help try to prevent any sort of infection and keep the area relatively dry
during the healing process. So I'm going to apply a gauze and a self adhesive wrap to
to cover this toe.
So this patient is going to be numb for the next 10 to 12 hours. When the freezing wears off,
she might feel a little bit of discomfort, a throbbing sensation in the toe, but as long as she wears open-toed shoes,
there should be little discomfort. The hardest time would be the first 24 hours. That's where my patients
usually feel the most discomfort
and then it really just goes down after that. It just really depends on the type of shoe
she's wearing, and how much pressure she's putting on this toe. She's going to be using an ointment that I prescribed for her
twice a day every day until she comes back to see me for one week. After that,
we should start to see a scab to form and she'll be coming back to the office usually three to four weeks after that and
by then we should see pretty much a healed area with a scab and that's really going to give us the first look to
see if there's any warty tissues left behind.
Sometimes if there is, we do a second round of treatment, but I usually don't do another surgical procedure. It'd be something like an
acid, a topical treatment or laser treatment that I offer in my clinic.
So there you guys have it another procedure done.
Something a little bit interesting, at least to me that is.
Looks from first glance, it looks like a corn, a very common place for corn, but ended up being something very different.
Not a very common place to find a wart, but it was we were able to handle it effectively efficiently. It's gone,
patients feeling great, and
hope you guys enjoyed seeing something a little bit different. Hope the video is a little bit more enjoyable,
wasn't distracting without any music, very very simple. So I have the next video plannedand I'm thinking of doing a
nail cutting of extremely thick and long nails. I just recorded it two days ago, and
I am going to probably leave the voice, the banter in between me and the patient, because people always love to hear that natural environment.
So that one I'll put out pretty quick because it's not going to take too much editing. So again,
thank you guys for all the love all the support,
giving the Feedback. I'll be watching, I'll be listening, I'll be responding. You guys are great!
Toe Bro, out.
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