Nail Fungus
Fungus infection of toenails afflicts approximately 30 million Americans. It is most prevalent after age 40, but may also infect younger individuals and children. Often, people are not aware of the fungal infection, because the condition is generally painless, and it takes many years for the nails to become deformed.
Some fungal toenails begin after trauma causes bleeding under the nail. Another cause is chronic athlete’s foot, which is a fungal infection of skin. The skin fungus eventually spreads to the nails. Once the nails are infected, they become a reservoir of the fungus, leading to persistent athlete’s foot. Factors that increase susceptibility to fungal toenails are hot humid weather, sweaty feet, poor circulation, diabetes and immunocompromised states.
Signs of onychomycosis
- Separation of the end of the nail from the nail bed
- Malodorous, soft, yellow material beneath the nail
- Thickened, yellow nails
- Chronic athlete’s foot
Onychomycosis is contagious and should be treated. It will not resolve by itself. Although fungal nails were difficult to treat in the past, current medications and treatment protocols can successfully cure the condition.
At Advanced Foot & Ankle Clinic, Dr. Silvers prefers to begin patients on a topical fungicidal nail lacquer called Formula 3.
Formula 3 is an oil-based nail lacquer that contains an active anti-fungal ingredient called Tolnaftate. Tolnaftate has been FDA-approved for over 50 years. Formula 3 has patented technology to make Tolnaftate oil soluble and can now penetrate the nail.
Our ½ oz. bottle will treat the nails for at least 3-4 months.
Formula 3 is an oil and requires no drying time. It is odorless and does not stain. It is absorbed by the nail in seconds. It is recommended to apply to the product and massage into the nail.
Oral anti-fungal drugs have revolutionized the way we treat fungus infections of the nails. Based on extensive experience with available oral fungicides, our doctors have chosen to prescribe Lamisil® tablets, because Lamisil® offers our patients a very high success rate.
Good foot hygiene can help you avoid fungus infection of the toenails.
- Do not walk barefoot in public areas such as pools, showers or locker rooms.
- Keep the toenails trimmed short so the fungus cannot latch on to unattached portions of nail.
- Keep the feet dry. Dry carefully between the toes after bathing and use a foot powder if your feet sweat a lot.
- Wash the feet daily, especially between the toes.
If you have questions or would like to discuss the treatment of toenail fungus, please contact Advanced Foot and Ankle Clinic in McKinney and Prosper, TX.
Over-the-Counter Orthotics vs. Custom Orthotics
Dr. Silvers of Advanced Foot and Ankle Center in McKinney and Prosper, Texas has years combined postgraduate training in foot and ankle conditions as well as custom orthoses providers.
The address to our facility is as follows:
McKinney Office Location
4501 Medical Center Drive: Suite 300
McKinney, TX 75069
To schedule an apppointment, please call : 972-542-2155
Prosper Office Location
140 N. Preston Road: Suite 30
Prosper, TX 75078
To schedule an appointment, please call: 972-542-2155
Proper Shoe Fitting
Proper Shoe Fitting
Most people would be surprised that a majority of foot problems are caused from poor shoe fitting. People choose shoes for many different reasons including comfortability, style and functionality. Just because a shoe appears to look comfortable and is expensive is not the criteria to use when purchasing shoes.
Shoes must fit properly, be made of sturdy materials, and have a solid construction. Due to the variability of people’s foot structure, a shoe may comfortable to one person and very uncomfortable to the next person.Shoes are designed to protect the feet during mobility and support. Unfortunately, improper shoe fit can limit joint movement, constrict circulation, decrease sensation and alter the way you walk. Poor shoe fit can also inhibit the proper functioning of custom-made foot orthotics.
If improper shoe gear is worn for a long term, the muscles, joints, and connective tissues in the feet begin changing shape, adapt to the shoe and cause many foot disorders.
Feet have been measured for years by a metal instrument called a Brannock Device. You have probably seen a Brannock Device in nearly every shoe store you have entered. The Brannock Device is used to measure 3 basic dimensions of the foot.
A. Heel to the ball of the foot
B. Heel to the tip of the toes
C. Width
Each measurement is used in combination to custom fit the shoe. The most important measurement is the heel to the ball of the foot, because this measurement will closely resemble how the shoe is designed to function. The shoe is designed bend at the ball of the foot, and if the shoe bends in the arch or doesn’t bend at all, this must be taken in consideration. The heel to the ball measurement defines the position of the arch and if this measurement is incorrect, the shoe and the foot will never function in harmony. Instead, they will fight each other with each and every step.
When measuring the heel to toe length, allow a minimum of a 3/8 to ½ inch distance from the tip of the big toe to the front of the shoe. If the toes touch the end of the shoes, this can cause trauma to the toenails and possibly cause hammertoes and can lead to ingrown toenails.
The heel should fit comfortably in the shoe with a minimum amount of slipping. In other words, the shoe should not ride up and down on the back of the heel as you walk. The heel of the shoe helps control rearfoot motion. A straight, solid heel in the shoe is very important especially in those who are flatfooted or pronate.When measuring the width of the foot, you must allow enough room in the shoe to accommodate the foot structure. If the foot is rubbing on the sides of the shoe, blisters, calluses and other problems can occur. If a patient has bunions or tailor’s bunions, this deformity can become increasingly painful with a smaller width shoe.
Make sure the ball of the foot fits comfortably in the widest part of the shoe. Don’t buy shoes too tight and expect them to stretch to fit.Take in consideration the height of the toebox in the shoe. Sometimes the tops of toes can rub on the inside of the shoes. In some people, especially those with hammertoes, this can become a problem. Allow enough room in the shoe so the toes do not rub.A slight heel is important, however avoid high heeled shoes whenever possible. High heeled shoes allow for the forefoot or the “ball of the foot” to bear the entire body weight. This can cause intense forefoot pain and ultimately cause severe deformities of the foot.All foot measurements must be taken weightbearing or standing. Since the foot lengthens and widens under physiologic loading, a false measurement may be taken if the foot is measured while sitting.
Most people have one foot that is larger than the other. Fit the shoe to accommodate your larger foot. Don’t select shoes solely based on the size indicated on the tag inside the shoe.
Select the shoe according to how it fits your foot or shaped like your foot. The “last” of the shoe is the so-called footprint of the shoe. The last can be straight or slightly curved inward. Everyday dress shoes are normally built on a straight last, while athletic shoes are built with a slight inward curve of the forefoot. Straight last shoes are recommended for patients using orthotics in their shoes.
Shoe material is also a consideration when purchasing the proper shoe. Durability, flexibility and breathability of the material has to be accounted for in the upper material of the shoe. If the material is too soft and flexible, you may not get the support and durability you are looking for. On the other hand, if the materials are too stiff and don’t “give”, they can be very uncomfortable and cause pressure. If you have feet with significant arthritic changes, it is very important to choose shoegear that will “mold” to the foot in order to take pressures off the deformity.People who have feet that sweat a lot need to find materials that breathe in an effort to get air to the feet during the day. Some shoes are designed to absorb sweat from the foot, but many do not. Naturally for those people whose feet perspire a lot, you should allow your shoes to thoroughly dry out before wearing them again.
Do not store the shoes in dark closet immediately after using them. Instead, store the shoes near an open window or on the front porch to fully dry out.
The sole of the shoe is a major consideration. Many people complain that the sole of the shoe is too stiff or too flexible. It is important to find a shoe with a happy medium. If you had to choose between a very flexible sole or a stiff sole, I would personally lean towards a stiff soled shoe. Shoes with excessive bend can cause a variety of foot problems.
Also, try to find a shoe that will accommodate your arch height. Most people bear weight on the heel and the ball of the foot. When barefoot, the arch is usually not supported unless you have a very flat arch. Therefore, try to find a shoe that accommodates the arch height to distribute the pressure across the entire surface of the foot. Be careful though, because too much arch in the shoe will cause the patient to bear weight primarily on the arch region of the foot and can cause severe pain.If you stand on hard surfaces such as concrete or tile, a shoe with proper cushioning is necessary.
Also if you participate in athletic activities, finding a shoe with good shock absorbing qualities is important. If hard soled shoes are worn in these situations, pressure calluses can develop on the bottom of the feet. Also, choose shoes that have a sole that will not slip. Soles should provide solid footing and not be slippery.Buy shoes in the afternoon or towards the end of the day. At the end of the day, the feet have expanded and swollen through activity and will be its largest size. The Brannock Device does not measure the “volume” of the shoe.Also, don’t forget to bring socks or panty hose to the store when getting fit for shoes. Many stores have socks to wear, but be prepared by bringing your own in case the store does not have them for you.
It is important to realize when your foot deformity cannot be accommodated by shoes bought from a shoe store. Those patients with chronic non-healing ulcerations or severe arthritic deformities and malformations need extra protection and shoes that are custom-molded to accommodate deformities and offload pressure areas. Dr. Silvers has extensive professional experience providing custom-molded shoes. Casts of your feet are taken in the office, sent to a specialized shoe-making company in which a shoe is fabricated to you own personal specifications. If you are diabetic or have one of the previously mentioned foot deformities, you should come see Dr. Silvers to determine if custom-molded shoes are needed for you.
Plantar’s Warts
Plantar’s Warts
A plantar wart (verruca plantaris) is a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot and typically resembles a cauliflower.
A plantar wart may have small black specks within it that bleed when the surface is cut or shaved; these are abnormal capillaries or blood vessels feeding the wart.
Though the name plantar wart describes specifically HPV infection on the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand, where the appearance of the wart is often exactly as described above for plantar warts. Because of pressure on the sole of the foot, a layer of hard skin forms over the wart.
A plantar wart may or may not be painful. It can be spread in showers, around swimming pools, by sharing shoes, etc. Plantar warts, can often be differentiated from corns by close observation of the skin lines. Feet, like hands, are covered in skin lines or “fingerprints”. With plantar warts, the skin “fingerprints” go around the lesion. If the lesion is not a plantar wart, the fingerprints continue across the top layer of the skin.
Plantar warts tend to be painful on with pressure from either side of the lesion rather than direct pressure. Corns tend to be painful on direct pressure rather than pressure from either side. The difference between plantar warts and warts on other parts of the body is that warts are generally outgrowth lesions, but on the bottom of the foot, they are pushed inward by the pressure of walking.
Since the skin on the bottom of the foot tends to be thicker, the treatment of plantar warts is more difficult.When discussing treatments, no treatment in common use is 100% effective.
Podiatrists are considered specialists in the treatment of plantar warts. Although immunization is available for the HPV and strains causing cervical cancer, there is currently no vaccination treatment for plantar warts.
The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with chemicals like Canthacure (canthiridin, derived from a blistering beetle) or trichloroacetic acid or salicylic acid. Cryosurgery with liquid nitrogen is a common treatment that works by producing a blister under the wart. It is painful but usually nonscarring. Lasers utilized in the operating room are also a great option.
Surgical excision of the wart is a last resort option but appears to be the most definitive for recalcitrant lesions.
Dr. Silvers have extensive training in using these products as well as surgical options concerning warts. Patiently waiting may be appropriate since many warts will eventually resolve due to the patient’s own immune system.
In many cases, the body will become naturally immune to the wart and the verrucæ will fall off, although it can be months to years before this takes place.Warts may spread, develop into clusters or fuse to become a mosaic wart. Plantar warts can be painful making it difficult to walk and run. Overaggressive treatment may lead to scarring. Others may get infected. If a wart is being treated professionally and does not seem to improve in a reasonable period of time, the growth should be excised and biopsied.
Avoid walking barefoot in public areas such as showers and public changing rooms. Change shoes and socks daily.
Avoid sharing shoes and socks. Avoid direct contact with warts on other parts of body.
Avoid direct contact with warts on other persons.
If you have a painful plantar’s wart and are seeking treatment, please come visit Advanced Foot and Ankle.
Diabetic Foot Care
Diabetic Foot Care
As a podiatrist (foot and ankle specialist), Dr. Silvers sees a large amount of diabetic patients at their McKinney, Texas and Prosper, Texas Office Locations. These patients are usually referred from primary care physicians or endocrinologists, or patients themselves concerned about their foot health come to our clinic. Diabetic patients have to take extra special care of their to prevent ulcerations, infections, and even amputations. Listed below are a few helpful tips for diabetics concerned with how to take proper precautions and protect their feet. Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday!
This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.
2. Check your shoes before you put your feet in them.
Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?”
3. Don’t walk around barefoot or in sandals.
Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.
4. Watch out for folds in your socks.
Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration. Avoid cotton socks and choose synthetic blends, polypropylene, acrylic, diabetic socks or small fiber wool blends.
5. Dry off your feet after showers and dry between your toes.
Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.
6. Don’t be a victim of fashion.
High fashion shoes usually lead to a high number of problems in the feet. 
Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.
7. Check your bath water with your hand before you put your foot in it.
The temperature your foot feels is much different from the temperature
your hand feels when you have neuropathy. Make sure to check the temperature with your hand. This will be much more accurate than testing the water with your foot.
8. Don’t use a heating pad on your feet.
This may cause burns without you realizing it. This has specifically happened to my diabetic grandfather who in result had to receive repeated wound care and eventually a skin graft to bottom of his foot.
9. Do not use medicated corn pads or any medicated pads from the local drug store.
These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your podiatrist.
10. Do not cut your own toenails.
If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.
11. Do not trim your own calluses or corns.
As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or calluses.
12. Lose Weight.
Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.
13. Exercise.
Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.
14. STOP SMOKING!
This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.
15. Visit a podiatrist regularly.
Pediatric Footcare
Pediatric Footcare
Several foot problems have their origin in childhood and are present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.
Foot symptomatology, seen in children, can lead to problems in other parts of the body, such as the legs and back. The child with troublesome feet walks awkwardly and usually has poor general posture. As a result, the child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatric physician and pediatrician helps to resolve these related problems.
THE INFANTS FOOT
The human foot has 28 bones, and is laced with ligaments, muscles, blood vessels and nerves. Since the bones in children’s feet are soft and pliable, abnormal pressure can easily cause deformities. A child’s feet grow rapidly during the first year, reaching almost half of their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet. The following are some suggestions to help assure that this development proceeds normally:
- Look carefully at your baby’s feet. If you notice something that does not look normal to you , seek professional care immediately. Deformities will not be outgrown by themselves.
- Cover your infants feet loosely. Tight covers restrict movement and can retard normal development.
- Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weightbearing.
- Change the infants position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.
WALKING
It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since age for independent walking ranges from 10 to 18 months.
When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength, as well as the grasping action of toes. When the child is walking outside or on rough surfaces, feet should be protected in lightweight, flexible footwear made of natural materials.
THE MATURING CHILD’S FOOT
As a child’s feet continue to develop, it may be necessary to change shoe and sock sizes every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness, or hereditary factors, improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down from one individual to another.
As the child grows, foot health examinations annually are recommended by The McKinney Foot Center.
SPORTING ACTIVITIES
Millions of America’s children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children’s involvement in sports that require a substantial amount of running and turning or that involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sport-related foot and ankle injuries are on the rise as more children actively participate in sports.
PARENTAL ADVISE
- Problems noticed at birth will not disappear by themselves. You should not wait until the child begins walking to take care of a problem that has been noticed earlier.
- Remember that lack of complaint by a child is not always a reliable sign of foot health. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.
- Walking is the best of all foot exercises, according to podiatrists. Podiatrists recommend that walking patterns be carefully observed. Does the child toe in or out, have knock knees, or other gait abnormalities? These problems can be corrected if they are detected early.
- Going barefoot is a healthy activity for children under the right conditions. However, walking barefoot on dirty pavements exposes children’s feet to dangers of infections through accidental cuts and to severe contusions, sprains or fractures. Another potential problem is plantar warts, a condition caused by a virus which invades the sole of the foot through cuts and breaks in the skin. They require protracted treatment and can keep children from school and other activities.
- Be careful about applying home remedies to children’s feet. Preparations strong enough to kill certain types of fungus can harm the skin.
- Whenever you have questions about your child’s foot health, you may contact Dr. Silvers at Advanced Foot & Ankle Center (972) 542-2155.
