Some causes of posterior heel pain can be trauma that results in a fracture or a boney bruise with or without inflammation to the Achilles tendon (tendonitis).  The pain can also be due to mechanical problems such as a tight heel cord (Achilles tendon).  In addition, bone spurs that result from long term pulling (traction) of the Achilles tendon can develop and produce a bump or prominence along the back of the heel.   Some types of arthritis can also cause spurs to the heel. 

Many times bone spurs along the back of the heel are not painful.  When they do become painful, the experts at Advanced Foot and Ankle Center in McKinney and Prosper, Texas can help you find relief.  Our treatment plans for posterior heel pain are conservative yet aggressive.  Dr. Silvers will evaluate your heel pain both clinically and radiographically (x-rays, CT and/or MRI if needed).  He may choose to have some blood work taken after conducting a history and physical examination.  Some conservative treatment options include heel lifts, walking boots, casting, oral steroids, oral or topical anti inflammatories, shoe modifications, physical therapy, and altering activity. 

If a course of aggressive conservative treatment fails after 3-9 months, then surgical options for patients who are surgical candidates may be explored.  Such surgical treatments involve addressing the heel spur and the Achilles tendon.  If Dr. Silvers finds that the Achilles tendon is short or tight, he will suggest lengthening in addition to removing the heel spur.   Dr. Silvers uses the most advanced techniques for treating heel spurs along the back of the heel.  Today, Dr. Silvers utilized the Arthrex Speed Bridge System.   “I like the Speed Bridge because it provides a stable and strong means of reattaching the Achilles tendon to the heel after bone spur resection.  In the 14 years since I have been performing poserior heel spur surgery, I have yet to find an anchoring system that matches up to the Arthrex Speed Bridge.  The speed bridge is nice not only that if utilizes 4-3.5 mm bioabsorbable anchors, but it is also a knotless system.  That means that we no longer have to bury knots within the tendon as it is reattached to the heel bone.  In addition, the criss crossing of the sutures attached to the anchors provides a wide surface area of compression to the Achilles tendon and the heel bone.”

Despite the great advancements to reattaching the Achilles tendon to the heel bone, recovery does take a minimum of 6 weeks of non weight bearing on the involved foot.  After the six week period, another 2-6 weeks of utilizing a walking boot is required. 

If you suffer from posterior heel pain (pain along the back of the heel) call Advanced Foot and Ankle Center to schedule an appointment to see Dr. Eric Silvers.  Dr. Silvers has patients that have come to Texas from all over the country to see him including, Florida, California, Arkansas, Oklahoma, Michigan, Illinois, just to name a few. 

You can reach us by calling 972-542-2155.  Our friendly staff is sympathetic to your heel pain needs and will do their best to get you into our office for a personalized consultation with Dr. Silvers directly.

A disadvantage of chemical matrixectomies is the healing time.  The process of healing is an inflammatory reaction from the chemical that causes the surgical area to drain.  If the entire nail is removed and a chemical matrixectomy is performed, healing time can be 3-8 weeks.  Partial nail removal with a chemical matrixectomy take 2-4 weeks to heal.

Some complications of the procedure include a recurrence of the nail spicule.  Sometimes the entire nail may be lost with performing partial nail removal on both sides of the nail plate. This is especially true if the nail is already thick and very curved prior to the procedure.   Formation of an abscess also may occur after a matrixectomy.  This occurs due to failure of the toe to drain.  This is why post operative follow up visits are very important.

Post operative care of a chemical matrixectomy is very important.  At Advanced Foot and Ankle Center, our physicians advise daily cleaning in the shower or bath with liquid soap and a wash cloth.  In addition, daily application of a wound gel known as Amerigel is important until the toe is completely healed. One may also soak the involved foot twice daily in warm water mixed with epsom salt and vinegar for 15 minutes twice daily and then cover the toe ointment and band aid.

Phenol and Alcohol chemical matrixectomies are another method of performed the procedure.  At Advanced Foot and Ankle Center our physicians choose to use sodium hydroxide over Phenol due to decreased recovery time with sodium hydroxide.

The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas have years of experience in performing ingrown nail procedures.  Our team will make you feel at ease as we treat your toenail condition.    Please call us at 972-542-2155 to schedule an appointment with one of our residency trained foot and ankle specialists.

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices  located in McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

The procedure is outlined below:

1. The toe with the infected toenail is numbed with local anesthetic at the base of the digit in order for the patient to be able to tolerate the drainage of the infection.

2. A small sliver of toenail from one or both sides (and sometimes the entire toenail) is removed. When the portion of the nail is appropriately removed, the nail border or nail bed is inspected for any remaining pieces of toenail that may be causing infection to be present. All pus and fluid is drained from the nail and disinfected.

It should be noted that when infection is present, a chemical matrixectomy cannot be performed. If a chemical is used to the kill or destroy the nail matrix from which the nail plate grows from, this can create a small “burn” area. If any residual infection decides to invade the area of the chemical burn, this can lead to a more serious infection and possible invasion of the bone underneath the nail plate.

It should also be noted that patients who have an I&D performed must realize that there is a high probability that the nail border may come back ingrown again. Therefore, it is important to return to our office before the toenail becomes infected again and have a chemical matrixectomy performed. This will ultimately prevent re-growth of the ingrown toenail.

If you have an infected toenail, please call 972-542-2155 to schedule an appointment immediately.

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices located in McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

1. Acral Lentiginous Melanoma:  10% of all melanomas. This melanoma is aggressive and invades very quickly. This melanoma occurs primarily on the soles of the feet, often on the digits or underneath the toenails. If this melanoma occurs underneath the toenail, it is called melanotic whitlow. This type of melanoma is usually found on non-caucasian individuals.

2. Superficial Spreading Melanoma: 70% of all melanomas. Occurs in younger people. Spreads from side to side before invading deep. Usually darkly pigmented, painful with irregular, asymmetrical shaped borders.

3. Lentigo Maligna Melanoma: 5% of all melanomas. This melanoma is the slowest growing and the least likely to metastasize. It is patchy with mottled pigmentation. It enlarges from side to side before invading deep. Occurs in sun-exposed areas. It is more common in patient older than 60 y/o.

4. Nodular Melanoma: 15% of all melanomas. This melanoma has the worst prognosis and becomes invasive very early. This melanoma commonly ulcerates.

It is very important to know that if you have a suspicious lesion on the toenail or foot, please have either a podiatrist or dermatologist examine the lesion as soon as possible. Biopsy should be performed in order to receive an accurate diagnosis. Please call 972-542-2155 for an appointment today.

Dr. Eric Silvers is a  highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices  located in McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has office located in McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

It is noted that if more than 25% of the nail plate has blood underneath it, the toenail should be removed to examine the nail bed or the skin underneath the nail. If more than 25% of the nail bed has blood underneath it, it is highly likely that the nail bed is lacerated or cut. This must be examined, because if the nail bed is lacerated, it is considered an open fracture and the nail bed must be appropriately cleaned, disinfected, and sutured.

If the hematoma is less than 25% of nail plate involvement, the blood can then be drained and the nail plate left intact. This is performed in our office with either a hand-held cautery tool or a sharp blade to bore a hole into the nail plate and allow the blood to escape.

If you develop a subungual hematoma, please seek assistance from our physicians. Call 972-542-2155 for an appointment today.

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices located in McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today

Acute trauma often is the result of dropping an object onto the toe or stubbing the toe against something that forces the nail plate to become separated from the nail bed.  Blunt trauma can cause subungual hematoma’s which is a collection of blood from under the nail plate.  This can cause pain and also can lead to infection.  If a subungual hematoma develops, the collection of blood will need to be drained by either creating a hole in the nail plate or by removing the toenail.  If it is not drained, the pressure will continue to build up and cause pain to the toe.  This can be done by using a needle, cautery or a laser.   Even though the hematoma is evacuated, lysis or separation of the nail plate from the nail bed can still occur and the nail plate may come off prior or during the re-growth of a new nail plate.

Blunt trauma can also lead to laceration of the nail bed that would warrant repair but suture.  In addition, blunt trauma can cause a fracture to the underlying bone (distal phalanx) that would also require treatment.  If the nail bed is traumatized along with a fracture to the distal phalanx, it is classified as an open fracture.

Open fractures have a high risk for infection.  If the bone becomes infected, IV antibiotics and/or removal of infected bone may be necessary.  This could lead to loss of a toe in extreme cases.

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices located at both McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

There are four different types of categories of onychomycosis.

1. Candidal Onychomycosis occurs when Candida (yeast) infects that nail plate.

2. Superficial White Onychomycosis (SWO) occurs when fungus infects the top layers of the nail plate.  One will see white islands of infection along the nail plate.

3.  Proximal Subungual Onychomycosis (PSO) and it occurs when the nail plate along the cuticle becomes infected with fungus.  This type of onychomycosis occures more commonly in immunocompromised individuals.

4. Distal Subungual Onychomycosis (DSO) and is the most common cause of onychomycosis.  The nail infection will begin along the tip of the nail plate and work its way back towards the base of the nail plate.

Onychomycosis can be caused by dermatophytes, Candida, and non dermatophytic molds.  The most common dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.   Candida infections are more often aquired in people that work with water.  Onychomycosis caused by molds is often seen in more tropical parts of the world.

Factors that place an individual at risk are occlusive footware, age, medical conditions such as diabetes and poor circulation, immunosuppression (HIV), trauma and warm climates.

North Dallas Ingrown Toenail Specialists recommend nail plate samples to be sent to histology lab for confirmation of onychomycosis.   This is done by taking a sample of the infected nail plate and sending it to a dermatopathologist for examination.

Treatment of an onychomycotic nail plate can be a long process since the infection is within the nail plate.   Current treatment options include topical medications such as Penlac which is a prescription topical nail lacquer and non-prescription, Formula 3 that is available at North Dallas Ingrown Toenail Specialists.

Oral medications include Lamisil which is the most effective oral antifungal.  Prior to being placed on this medication, it is highly advised that you have a blood test to check your liver enzyme levels (AST and ALT) to confirm that you are healthy enough to take the medication.

The newest form of treatment of onychomycosis is by laser.   There are currently ongoing studies for this method of treatment.  The physicians at North Dallas Ingrown Toenail specialist currently do not offer this type of treatment for onychomycosis since they feel that current outcomes do not justify the cost of this modality.

Dr. Kory Williams and Dr. Eric Silvers are highly-trained foot and ankle surgeons specializing in the treatment and resolution of toenail pathologies.

Both physicians are located at both McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!