Lawnmower Foot Injuries
Now that it is summer, the yardwork becomes a necessity. It is important to follow some simple rules to prevent a lawnmower foot injury.
1. Don’t mow your lawn when it is wet. You could slip under mower and hurt your foot pretty bad.
2. Don’t mow the lawn barefoot or while wearing flip-flops. Wear heavy duty tennis shoes or work boots.
3. Don’t let your kids sit with you on the riding lawn mower.
4. Don’t mow up and down slopes. Mow across the slope.
5. Never pull a running lawn mower backwards.
6. Make sure the bag is attached to lawn mower. This could prevent projectiles from penetrating your foot.
7. Use a lawn mower that shuts off automatically when your hands let go.
By following these simple rules you may prevent a toe or foot amputation.
If you suffer from a lawn mower injury please seek your nearest Emergency Room or come see Dr. Eric Silvers in McKinney and Prosper for treatment.
Chronic Ankle Instability
Do you feel like your ankles could give out on you at any time? Do they feel weak and rubbery? If you have suffered multiple sprains in the past, you may have weakened or even tore or ruptured the ligaments around your ankle joint.
People with weak ankles often complain of the following symptoms:
1. Multiple ankle sprains, especially when walking or running on surfaces that are uneven or when the terrain is not flat.
2. Swelling and pain of the ankles that really never goes away
3. The ankles feel weak and wobbly
People develop ankle instability usually from having an injury that was treated appropriately or the patient did not properly rehabilitate the ankle. As previously mentioned, if the ligaments were stretched, torn or ruptured, your balance will be affected. It is very important to retrain the tissues to become strong again and sometimes the muscles around the ankle joint have to be strengthened. The more times you sprain your ankle, the weaker your ankle becomes.
Diagnosis of ankle instability is performed by evaluating the ankle clinically and checking for areas of tenderness. X-rays are usually taken and sometimes an MRI may be needed to fully assess the ligaments to examine for more serious injuries.
Conservative treatment for ankle instability includes physical therapy to strengthen the ligaments and the muscles around the ankle joint, help your balance, and increased the range of motion of the ankle joint. Anti-inflammatory medications also help with swelling and pain associated with the ankle. Ankle braces are also a mainstay because extra support may prevent additional sprains which further weakens the ankle.
Sometimes surgery is needed to repair the ankle ligaments, especially if they are torn or ruptured.
If you have lateral ankle instability and you want a professional opinion, please make an appointment with Dr. Eric Silvers so he may assess your ankle and determine what the best treatment for ankle may be.
Ganglion Cysts
Ganglion cysts are little bags of a syrup-like substance resembling a mixture between Vaseline and KY jelly. Ganglion cyst usually develop from tendon sheath or from a joint capsule.
A tendon sheath is the “tunnel” that a tendon passes through. The sheath is very thin. If the sheath get a weak spot, it bubbles out. I like to compare this to a football. The leather pigskin that surrounds the foot is tough and strong, but if there is a defect in the stitching, the air bladder on the inside will bubble out. This is somewhat how a ganglion forms. However, the bubble fills up with a viscous-like fluid.
The same thing happens in a joint capsule. When to bones come together, that forms a joint. Almost every joint in the human body has a joint capsule that surrounds the joint. The joint capsule holds in joint fluid to insure the joint is moist and provides a smooth slick surface for the bones to move against one another. If the joint capsule get a weak spot like the tendon sheath, then an out-pocketing can form and you get a bubble filled with a clear jelly like substance.
Ganglion cysts usually cause pain by putting pressure on something next to it.
If the ganglion is close to a nerve, then you may have nerve pain, like numbness, tingling or shooting pains.
If the ganglion is close to a tendon or joint, you may get a dull pain or ache.
Most of the time, ganglion cysts are relatively asymptomatic when barefoot, but when you put on a pair of tight shoes, the cyst causes pain on the adjacent structures.
When we evaluate your cyst, we look for a few key features to make sure it is actually a ganglion.
First, the skin overlying the cyst is usually not stuck to the cyst and moves freely.
Second, the cyst is does not typically cause skin discoloration, unless there has been friction inside the shoe.
Thirdly, we can turn off the lights in the treatment room and shine a flashlight by the lesion and the whole lesion should light up. If the lesion is solid and not fluid filled, this will not occur.
Fourthly, we can use a needle to draw out some of the jelly-like substance.
Lastly, advanced imaging studies like an MRI can give us a better idea how big the cyst is and what is inside of it.
Treatment
1. Nothing. Sometimes the cysts will bust on their own. Back in the old days, people used to hit them with a Bible to rupture the cyst.
2. Shoe modification – sometimes wider or deeper shoes are needed to avoid putting pressure on the cyst.
3. Aspiration and injection – Most often, we can use a needle to draw out all of the jelly like substance, then inject a steroid in shrink the size of the cyst. This is usually done on the 1st visit.
4. Surgery – If the previously mentioned techniques were performed without any success and the cyst keeps coming back, then we suggest excision of the cyst. This is the most definitive treatment and is very successful.
If you have a ganglion cyst, and you want to have it evaluated, please visit Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX for an evaluation and treatment.
Pediatric Heel Pain
What causes heel pain in children?
Although many more adults suffer from heel pain, children do as well. Although the main cause of heel pain in adults is PLANTAR FASCIITIS, the main cause of pediatric heel pain is something called Calcaneal Apophysitis, or Sever’s Disease. “I tend to use the term Calcaneal Apophysitis versus Server’s Disease” states Dr. Eric Silvers of Advanced Foot and Ankle Center in McKinney and Prosper, Texas. Dr. Silvers states, “Basically the condition is an inflammation of the growth plate (apophysis) of the heel bone (calcaneus). When something is inflamed the medical profession will add “-itis” to the end of the part that is inflamed, i.e. calcaneal apophysitis.
What causes calcaneal apophysitis in children?
The strong Achilles tendon inserts along the back of the heel and attaches to the bone that is between a secondary growth center of the heel bone. The heel bone has two growth centers. The primary growth center is located in the middle of the heel bone. Growth centers start out as cartilage and then eventually turn into bone as the bone matures. When looking at an x-ray of a growing child you will see two boney islands separated by a boney void that represents the secondary growth plate (physis) at the back of the heel. In some kids, mainly active children, the Achilles tendon will irritate the secondary growth plate and produce pain. It is believed that the cause is due to overuse or micro traumas that the tendon places on the bone during activity. It is more common to see this problem when the child is playing on hard surfaces a lot such as a basketball court or a dry soccer field. In addition, a tight calf muscle or Achilles tendon will irritate the secondary growth plate more aggressively than a tendon that is not tight.
What are the symptoms?
Typically, calcaneal apophysitis is seen more commonly in overweight males, but since I have been in practice, I am seeing more fit females suffering from this condition. The child will complain of pain in the back of the heel during and/or after athletic activities. Along with pain at the back of the heel, the child at times may complain of pain along the bottom of the heel. In addition, the heel pain is aggravated when the back of the heel is squeezed and high impact activities such as running or jumping will aggravate the problem. One or both heels can present pain and the pain may be so acute that the child has a noticeable limp.
How is calcaneal apophysitis treated?
I typically advise my active pediatric patients who suffer from heel pain to eliminate high impact activities for a period of two weeks. I also get them into an adjust a lift heel lift and advise them to avoid going barefoot. Gentle stretching of the calf muscle is also helpful as is icing and Biofreeze application. Icing the heel 3 times a day for 20-30 minutes at a time has shown good outcomes. In cases where the child has a pronated or flat foot, a custom molded foot orthotic with a heel lift is highly advised. In more stubborn cases, oral and/or topical non steroidal anti-inflammatory medication are helpful and also cast or walking boot immobilization has been utilized in our practice.
It should be reassuring to know that the problem is self limiting and will subside once the heel bone stops growing.
If you have any questions about this condition, please call 972-542-2155 and we will be happy to help you out.
Dr. Silvers is residency trained in medical and surgical treatment of all foot and ankle problems.
Where Do We Perform Surgery?
Dr. Eric Silvers is a podiatric surgeon who performs surgery on the foot and ankle. Patient are usually curious to know which facilities we operate out of. The three main locations where Dr. Silvers performs procedures:
1. Surgery Center at Craig Ranch
Please visit the above mentioned links for more information.
Thank you!
Calcaneal Apophysitis (Sever’s Disease)
As kids grow into adults, their bones have multiple growth plates. One growth plate in the back of the heel tends to be a common problem for many children. Children can inflammation of the growth plate and this causes severe pain. Podiatrist call the growth plate on the back of the heel the “calcaneal apophysis”. When you get inflammation of the calcaneal apophysis it is called calcaneal apophysitis.
Calcaneal apophysitis usually affects kids between the ages of 8 – 14 y/o. I would say the most common age is 10 y/o. The growth plate on the back of the will eventually incorporate into the rest of the heel bone after age 14.
When your kid is very active or participates in many sports, stresses can be placed on the growth plate and inflammation can occur. The heel’s growth plate is very sensitive to repeated running and pounding on hard surfaces, resulting in strain of the muscles and inflammation. Also, kids that may be a little on the heavy side may be more susceptible. Other things like a tight achilles tendon, flatfeet and high-arched feet can also predispose children to this condition.
Symptoms include the following:
1. Pain in the back or the bottom of the heel
2. Limping
3. Kids will walk on their toes
4. Difficulty participating in sports that require sprinting or jumping
5. Pain with side to side squeeze of the heels
Diagnosis is usually made by clinical evaluation and x-rays. Sometimes advanced imaging studies like MRI or CT is ordered as well as blood labs.
Treatment
1. Reduce the child’s activity – if the child has pain with running, the kid should stop running
2. Heel lifts – by placing a temporary wedge under the heel, strain or pull of the achilles is lessened and will reduce the tension on the growth plate on the back of the heel
3. Anti-inflammatory medications – NSAIDS or steroids
4. Physical therapy – sometimes stretching and other physical therapy techniques help significantly
5. Casting – in severe cases of apophysitis, a below-knee cat is applied and the child is advised to be non-weightbearing.
Calcaneal apophysitis can be very difficult to get rid. Oftentimes, the biggest hurdle to cross in healing the heel is making the parents understand that their kid needs to take a break from sports or physical activity. Sometimes, parents have their kids involved in so many activities, the heel and growth plate never has an opportunity to relax and heal.
If your child has heel pain and you want them to be seen by a specialist, please consult Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX & Prosper, TX.
