It was just another day in my NYC podiatry practice. I walked in the room and there she was. Sitting on the exam chair with her bipedal appendages at the end of a lower extremity artfully propped up on the happy feet towels. As I sat down in my rolling chair I took a closer look, and there it was, as clear as the nail polish on her toes. She was a smoker, and it was written all over her feet, like a bad book with a sad ending. I’m no detective, just a city doc with a nose for smokers’ feet.

We have covered this topic before, for those keeping track, but I felt it bears repeating and there remains 16.8% of the population (CDC, 2014) that continues to smoke, and at least some of those approximately 50 million people may be my patients. Here are some facts to help those who may be on the fence about continuing to smoke. Around the turn of the 20th century, lung cancer was a rare disease – less than 1% of all cancers – and a matter of interest and intrigue to doctors and medical students. Then, in World War I, soldiers learned to smoke and brought the habit home. The numbers increased exponentially during World War II and lung cancer subsequently increased to 20% of all cancers in the US. And it’s not just lung cancer, there are all sorts of nasty diseases that are more common in smokers: emphysema, heart disease, other types of cancer, and amputations of various lower extremity appendages. For those not as severely affected, there are the more subtle skin changes that I have come to observe, thickened nails, waxy skin and a noticeable change in texture. As a bonus, bone takes 42% longer to heal, and the rate of infection and skin breakdown is higher after surgery. It’s for this reason, and as a deterrent, that I stopped performing elective surgery on smokers.

The number of smokers in the US has been declining slowly since the Surgeon General published the now infamous report in 1964, but there are still plenty of smokers, and the numbers favor the young, male, poor, and minority population. In addition to all the reasons listed above it’s pretty nasty, expensive and not very socially acceptable anymore, and it has to be done outside in the cold and nasty weather. So if you’re a smoker, or know a smoker, maybe it’s time to stop something that is very clearly detrimental to health in a lot of rather gross ways. Not so cool, right Marlboro Man?

See you in the office.

Ernest Isaacson

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Ernest L Isaacson DPM PC
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