A Non-Invasive Treatment for Plantar Fibromatosis
Plantar fibromatosis is a fibrotic tissue disorder which is non-cancerous and is characterized by the presence of excess collagen or fibrotic tissue. The most common symptom of plantar fibromatosis are the dense, firm nodules that can be felt just under the skin on the bottom of the foot. The nodules are painful with standing or walking. Plantar fibromatosis does not resolve on its own.
Plantar fibrmatosis is diagnosed most often in the middle-aged and elderly population, but can affect all ages. It also affects men 10 times more often than women. Caucasians of northern European descent tend to be affected more than other ethnicities.
Plantar fibromatosis is a fibrotic tissue disorder of the plantar fascia that consists of excess collagen or fibrotic tissue. It is commonly located the arch of the foot in a tissue layer called the plantar aponeurosis. An exact cause of plantar fibromatosis is unknown; however, there are some potential causes that most podiatrists agree may play a role in the condition.
Trauma to plantar fascia is thought to be a primary cause of plantar fibromatosis. The trauma may be a form of puncture through the bottom of the foot or from repetitive impact from activities such as running or climbing. It is also thought that plantar fasciitis may lead to tears in the tissue causing plantar fibromas to occur.
Many patients may be genetically predisposed to plantar fibromatosis. Caucasians of northern European descent are affected the most while Asians are affected the least.
Medications such as beta blockers are have also been linked to plantar fibromatosis. Also anti-seizure medications such as phenytoin and certain supplements such glucosamine/chondroitin and large doses of Vitamin C have been linked to excess production of collagen.
Plantar fibromatosis has also been linked to chronic liver disease, diabetes and seizure disorders, as well as, long-term alcohol abuse.
Invasive Treatment Options
1. Corticosteroid injection into the fibroma
2. Surgery – complete removal of the fibroma or the entire plantar fascia
Non-invasive Treatment Options
1. Stretching
2. Padding
3. Orthotics
4. Physical Therapy
5. Transdermal Verapamil 15% Gel
Transdermal Verapamil 15% Gel is a painless, non-invasive, treatment for plantar fibromatosis. The medication is applied to the skin twice daily. Verapamil belongs to a class of medications called the calcium channel blockers. The gel has been designed to carry the verapamil through the skin and deliver it to the fibroma.
The gel allows the progression of the condition to be slowed or stopped and also to decrease the size of the fibroma.
If you have plantar fibromas and want to have them treated, please come see Dr. Eric Silvers at Advanced Foot & Ankle Center located in both McKinney, TX and Prosper, TX.
Please call 972-542-2155 to set up an appointment today.
Are you concerned about a firm knot in the arch of your foot? If you are, you may have something called a plantar fibroma. This foot problem is a firm fibrous mass that forms within a long ligamentous like structure along the bottom of the foot call the plantar fascia. The plantar fascia runs from the heel bone (calcaneus) to the soft tissues in the forefoot. Plantar fibromas are not malignant (cancer) but they are a slow growing benign tumor and seldom resolve on their own without treatment.
Fibromas are firm when they are touched and sometimes can grow and it is also not uncommon for one to develop more than one fibroma. They can be seen in only one or two feet. Pain is sometimes present due to shoe pressure and at times when the patient is barefoot on hard surfaces.
Diagnosis is typically attained by seeing an experienced Podiatrist. Dr. Eric Silvers of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have extensive experience in treating plantar fibromas both non surgically and surgically. Sometimes a biopsy or advanced imaging studies such as an MRI are needed to confirm the diagnosis.
Non surgical treatment includes cortisone injections that have been show to decrease any pain associated with the fibroma and also the size of fibromas. It is not advised to receive any more than 3 injections in one year’s time. Also custom foot orthotics are often helpful in that they help to distribute pressure from around the painful mass. Topical medications such as topical antiinflamatories and topical verapamil have been effective for some patients.
Surgical excision is typically carried out if conservative treatment fails. One should choose a foot and ankle surgeon who has training and experience in removing the plantar fibromas. Custom foot orthotics are needed after excision of the fibroma since many surgeons advocate removing the entire plantar fascia to decrease recurrence.
Dr. Silvers is currently accepting new patients who are seeking treatment for not only plantar fibromas but also any other foot and ankle problem.
Soccer linked to ingrown toenails in kids
Tight cleats and repetitive kicking can lead to a painful problem. Toes and feet can take rigorous toll on the feet, especially in sports.
Foot and ankle surgeon, Eric Silvers, DPM, says he treats many children who play soccer for ingrown toenails. He feels that poor toenail trimming, tight soccer cleats, and trauma to the nails caused by kicking creates this painful problem.
Dr. Silvers states that there are preventative measures mother and fathers can take to keep their kids from suffering from a painful ingrown toenail. First, teach the children to trim the toenail straight across and not too short. Second, make sure the athletic shoes fit properly.
It is important to know that a child’s shoe size can increase during a single soccer season.
If a kid develops and ingrown toenail, soaking the toe in Epson salts and warm water, along with massaging of the skin on the side of the nail can help with inflammation. Parents should be forewarned about the dangers of home surgery. Do not perform surgery on your child’s nail. This can lead to increased opportunity for infection and malformation of the toenail.
If your child’s toenail looks infected, it is time to seek treatment from a podiatrist.
Dr. Silvers can remove a child’s ingrown toenail and keep it from coming back with a short 5-10 minute procedure. This short procedure entails numbing up the toe, removal of the ingrown portion of the toenail, and removal of the nail root to prevent it from coming back.
Most kids have very little discomfort afterwards and can go back to normal activity the next day following the procedure.
For more information about ingrown toenail and pediatric foot problems, contact Advanced Foot and Ankle Center at 972-542-2155 to schedule an appointment.
Shin Splints
Why should you get treatment for this problem?
The shin is an area of the body that is highly susceptible to injury especially in sports such as soccer, football and running. If shin splints are left untreated, the injury can be very progressive, very painful and ultimately prevent you from participating in your sport and activity. In the early stages of this problem, it is important to seek treatment quickly from a podiatrist. This is very important in order to allow you to return to your sport as quickly as possible.
What are Shin Splints?
Shin splints is a “trashcan term” for multiple problems that can occur between the ankle and the knee. It can be divided into categories such as stress fracture, exercise-induced compartment syndrome, muscle injury and ligament and tendon injury and periostitis.
What are the possible causes of Shin Splints?
The potential causes of shin splints are as follows: The muscle attachment is sometimes strained by the ankle and foot excessively rolling in, which is a motion caused pronation. Stress fractures can occur by repetitive loads on the bone. Compartment syndrome occurs when there is such an increase in the bulk of the muscle which ultimately causes a loss of blood flow to the area. This causes the muscle to be squeezed in its “compartment” and this causes excessive pain, loss of sensation, cramping and aching of the leg. The most common cause is a sudden increase in activity, which cause the muscle to increase in size and become too big for the muscle compartment.
Conservative Treatment for Shin Splints
1. Orthotic therapy: re-balancing the feet and realigning the whole body is vital in controlling abnormal motions such as pronation
2. Temporary taping of the foot, ankle and knee can help in the early stages.
3. Wear appropriate athletic shoes can aid in alignment and proper shock absorption.
4. The podiatrist can give you stretching techniques to alleviate the pain with activity.
5. Elastic bandaging of the legs can prevent excessive muscle swelling.
6. Anti-inflammatory medications can help.
7. Rest and elevation of the limb can increase blood supply to the limb.
8. Varying the type of activity and exercise can help decrease symptoms, such as alternating running with biking or swimming.
Other Treatment
Sometimes x-rays have to be performed to R/O stress fracture of the leg bones.
If you have shin splints, please seek treatment from Dr. Eric Silvers at Advanced Foot and Ankle Center in McKinney and Prosper, TX.
Please call 972-542-2155 to schedule your appointment today.
What If Your Toenail Doesn’t Actually Have Fungus?
Sometimes toenails may be thick, yellow or green, disfigured, and have debris or “build-up” under the nail plate. Usually, my first instinct is to think nail fungus. However, you would be surprised how often that fungus is not the culprit.
At Advanced Foot & Ankle Center, nail specimens are sent to a lab for analysis to determine of fungus is present in the toenails. This is done to prevent you, the patient, from taking unnecessary antifungal medications and other products that are necessary.
So the big question is…….what is causing this? Well, there are many things that cause they same symptoms as nail fungus and I will explain the more common problems.
1. Onychauxis
- this can manifest as thickening or “hypertrophy” of the nail plate. This is usually treated with a medications that decrease the amount of keratin (the substance that makes up nails and hair). Usually urea-based products such Keralac Nail Gel with 50% urea is utilized.
2. Psoriasis
- Nails can have pits (like a miniature ice cream scoop taking divots out of the nail plate.). Nail can have oil spots or brownish-yellow discolorations of the nail plate.
3. Lichen planus
- Nails can have longitudinal ridging, irregular pitting, nail plate splitting, nail loss and thin brittle nails.
4. Reiter’s Disease – rare
5. Pachyonychia Congenita – rare
6. Darier’s disease
- longitudinal ridging as well as red and white longitudinal streaks. The distal nail edges may have V-shaped notching and thickening under the distal part of the nail.
7. Norweigen Scabies - rare
8. Subungual exostoses
- an bone spur can push up into the nail causing a big “hump” in the nail plate and cause the nail to grow awkwardly
9. Melanoma or cancer
- Melanoma and other types of cancer such as carcinomas can manifest different ways. Usually increased pain inthe nail with dark pigment changes are common.
