- Ingrown Toenails
- These occur more commonly in adolescents but may also be present in younger children due to picking/tearing their nails, neglecting proper foot care, or improper daily or athletic shoegear.
- Typically antibiotics alone will improve the cellulitis and pain for a short time however, if the nail appears incurvated a nail procedure is necessary.
- Plantar Warts
- Warts on the bottom of the foot are much more resistant to typical wart treatments such as liquid nitrogen or salicylic acid.
- Warts may be very painful to the child when walking and many times are confused with a foreign body.
- Tinea Pedis (Athletes Foot)
- Tinea Pedis is the most common skin problem in children and may appear interdigitally, as small vesicles on the foot or as scaling skin in a moccasin distribution.
- Treatment starts with discussing proper foot hygiene including shoegear rotation and proper socks as well as prescription topical medications.
- Crossover Toes/Curly Toes
- In children crossover toes or curly toes are the most common physical foot complaint.
- Typically the deformity is flexible up to about age 12 and if caught early can be treated with conservative methods such as different taping methods or specific padding techniques.
- Hallux Abducto Valgus (Bunions)
- Adolescent bunions are more common in females than males and are typically hereditary caused by abnormal mechanical function of the foot.
- Treatment starts with custom molded orthotics in order to improve mechanical function of the foot and decrease 1st metatarsal phalangeal and 1st metatarsal cuneiform joints motion.
- Intoeing Gait
- Many times parents first notice their child’s toes and legs turning inward and are worried because their child seems to trip or fall more than other children their age.
- Intoeing may be caused by many different conditions and each cause requires a specific modified treatment. These conditions include: metatarsus adductus, abnormal femoral torsion, abnormal tibial torsion, genu varum, and abnormal rearfoot pronation.
- Toe Walking
- In young kids first learning to walk toe walking is fairly common. It typically resolves itself by age 3. If still present after age 5 it can be a sign of short Achilles tendon, Muscular Dystrophy, Cerebral Palsy or Autism.
- Many times bracing, orthotics, physical therapy and at home exercises can improve the toe walking condition.
- Flat Feet
- Very young children will have the appearance of flat feet due to a large fat pad until about the ages of 3-4. This is when the arch begins to take its more characteristic appearance.
- This condition can be flexible or rigid and when rigid many times there is an underlying abnormal bony coalition causing the flat foot.
- Children when treated early with orthotics can prevent foot problems into the future including the need for surgical correction.
- Metatarsal Adductus
- This is a transverse plane deformity of the forefoot on the rearfoot and if not caught until the child is walking can give the appearance of intoeing gait.
- When caught when the child is younger than 6 months treatments can include serial casting or certain bracing devices to correct the problem non-surgically.
- Growth Plate Injuries (Sever’s Disease, Calcaneal Apophysitis)
- Most common cause of a child limping and complaining of pain is a growth plate injury either from direct trauma, overuse during sports activities, or abnormal body mechanics.
- Growth plate injuries from direct trauma must be taken seriously and appropriate immobilization with casting is required.
Drs. Silvers, Hadfield and Lloyd each has had special training in working with each child indiviually to give them the best most compassionate treatment around. Call our office today to make and appointment if your child suffers from one of these conditions at 972-542-2155.
Bunions and the Geriatric (Elderly) Patient
Authored by Dr. Eric Silvers
At Advanced Foot and Ankle Center in McKinney and Prosper Texas, we see many types of bunions in age groups ranging from 6 years old to patients in their 90’s and even 100’s. Often, the geriatric patient (patients 65 years old and older) hesitate about having their bunion corrected. Many feel that their age is a factor or do not want to consider any type of treatment. However, the truth is, we are living longer and healthier lives these days and a plethora of treatment options for painful bunions is available to the geriatric patient.
Upon presentation at our office, each patient with a bunion is evaluated from a musculoskeletal, biomechanical, circulatory and a neurological standpoint. Our providers listen to the patients complaint in order to provide the best treatment option for the patient. In office radiographs are also taken to assess the severity of the bunion deformity and the patients overall bone health. A comprehensive review of the patient’s medical condition and current medications is also important. Certainly, any type of surgery on a geriatric patient comes with additional risks such as a higher incidence of blood clots, bleeding and clotting issues especially those on blood thinners, delay healing due to chronic illness such as inflammatory arthritis, diabetes, neuropathy, prolonged steroid use, smoking, etc.
Often times, conservative treatment options for those patients that simply have pain from the bump of the bunion can be accomplished by padding and wider shoes. However, long standing bunions typically come with more deep aching symptoms due to the onset of arthritis. When advanced arthritis is present, the patient often has pain with motion of the great toe joint. In addition, large bunions can cause pressure pain and pressure sores along the second toe. Also, the big toe can crowd the second toe and cause a second toe hammer toe or even dislocation of the second toe from the joint at the base of the toe. When this happens the patient often complains of pain under the ball of the foot.
If the geriatric patient chooses to explore options for bunion surgery, the surgeons at Advanced Foot and Ankle Center will discuss the best procedure for the patient. The procedure chosen is based on several factors including the severity of the bunion, bone health, patient health and ability to heal and patient goals after bunion surgery. If the patient has other medical conditions including but not limited to high blood pressure, diabetes, arthritis, heart problems, etc, a preoperative clearance from the patients primary care physician will be required. Once the patient is cleared to have the surgery, further discussion of the procedure will be carried out.
There are many types of bunion procedures that are performed. The bunion procedures do vary based on the factors previously mentioned. Some of the procedures include: simply shaving down the bone on the metatarsal head, resecting a portion of the joint, hemi or total joint replacement, cutting and shifting the bone and stabilizing the bone with a pin, screw and/or plate, fusing the great toe joint, or addressing severe bunions by fusing a joint in the midfoot and placing a plate and screws to allow the bones to heal.
With increased age come increased risk factors. Some of these include a blood clot in the leg (Deep vein thrombosis or DVT) and/or an embolism (moving blood clot) after surgery. Increased risk factors associated with blood clots include a past history of a DVT, immobilization, a history of cancer or presence of systemic clotting disorders. Some bunion procedures require casting and prolonged immobilization post operatively that can increase the risk of DVTs. For those patients that have an increased risk of DVTs, lovenox can be given preoperatively.
As stated previously, assessing bone health prior to surgery is important. Problems such as osteoporosis and vitamin D deficiency without supplementation can post a problem with shifting bones due to bone softness associated with these problems. In addition, smoking, alcohol and long term steroid use can contribute to poor bone health leading to poor healing outcomes. At times a DEXA scan is ordered to further assess the patients overall bone health.
Geriatrics who are diabetic may still be good candidates for bunion surgery as long as their blood sugars are under good control. We typically like to see HbA1C levels below 7.
Patients that suffer from neuropathy will also have a longer recovery and possibly more aggressive offloading (non weight bearing) after the surgery due to their decreased sensation and increased risk of injury after surgery.
Post operative evaluation by a physical therapy is often encouraged by the surgeons at Advanced Foot and Ankle Center. Often, we ask the therapist to go into the patients home to assure that it is safe for post operative care. The therapist will assist with post operative gait training with the shoe, boot or cast. They will also assess if there are any fall or tripping hazards in the home. In addition, the geriatric patient is strongly advised to have a family or friend readily available during the post operative period to help with meals, errands, mail, pets and daily tasks.
In conclusion, bunion surgery and the geriatric patient are often a good combination if appropriate workup, planning and risks are assessed. If you are thinking about having bunion surgery, regardless of your age, please call the experts at Advanced Foot and Ankle Center and we will be glad to answer all of your questions. Our phone number is 972-542-2155 and our website is www.advancedfoottexas.com
North Texas weather isn’t known to be consistent. With some days in the 70’s and then the next below freezing, it’s easy to reach for that coat and gloves without paying much attention to the warmth of your feet. Keeping your feet warm is important, especially for those that have decreased circulation.
There are many conditions that can cause decreased circulation in the feet including a history of smoking, Diabetes, Raynaud’s phenomenon and Peripheral Vascular Disease. Those that suffer from any one of these medical conditions are more prone to complications with the cold weather including frost bite and wounds that won’t heal. Smoking causes the small blood vessels to not allow proper blood flow resulting in decreased nutrients and oxygen to the tissues and skin on the toes and feet. Many times diabetic patients develop a nerve problem called Peripheral Neuropathy that doesn’t allow them to sense how cold there feet really are, making them unable to sense when they are becoming dangerously cold and need to be warmed up. Raynaud’s phenomenon occurs when a person’s body overreacts to the cold causing the small blood vessels in the feet or hands to constrict which cuts off the blood flow to that area resulting in color changes. Raynaud’s can be seen alone or sometimes is associated with other conditions. Peripheral Vascular Disease occurs with plaque builds up in the arteries causing a reduction in the amount of blood able to reach the feet and toes. This lack of blood flow can start as the feeling of cold feet but may develop to ulceration and skin loss if not treated.
The Podiatrists at Advanced Foot and Ankle Center recommend those that are at increased risk of circulation problems be evaluated in the office in order to ensure there are no problems with the winter month’s cold snaps. Use of heavy wool socks while outside and being sure to wear closed toed shoes are important. If you are spending an extended period out in the cold be sure your feet stay dry and take periodic breaks, moving into a warm location to let your feet warm back up.
Luckily in Texas our winters go by quickly but they can still be cold and everyone needs to take precautions to keep their feet healthy in the cold. The Doctors at Advanced Foot and Ankle Center in McKinney and Prosper Texas have training in treating those with foot problems associated with smoking, Diabetes, Raynaud’s phenomenon and Peripheral Vascular Disease. Make an appointment today to be evaluated and keep your feet healthy all winter long. Call 972-542-2155 to make an appointment with one of our three residency trained Podiatrists.
Foot and ankle injuries are among the most common in athletes at all levels and in nearly all sports. Whether it be football, baseball, basketball, hockey, track and field, gymnastics, figure skating, distance running, lacrosse or tennis, athletes can be sidelined from a variety of foot and ankle ailments.
One of the best examples in recent years has been Yao Ming formerly of the Houston Rockets. His career was hampered by a recurring bone fracture that caused him to miss many games each season and ultimately cut short his promising career. He repeatedly fractured his 5th metatarsal bone in an area (called a Jones’ fracture) that has a difficult time healing in a regular sized person, let alone someone who is well over 7 feet tall. Non healing bone causes chronic pain that can bring even the toughest player down.
Another example is Peter Forsberg, who was one of the best players in the NHL. He was born with poorly aligned ankles which caused many missed games and forced an early retirement. Hockey skates in the best of circumstances are very hard on a person’s feet, but are particularly harsh on those with poorly aligned feet and ankles. To compound matters, professional athletes have endorsement deals with shoe (or in this case skate) companies for footwear that may not be the best for their feet. For more on Forsberg’s ankle issues click here: http://www.denverpost.com/avalanche/ci_26950768/peter-forsberg-had-unique-mix-elite-skills-physical
Arguably the most common injury (and one of the most overlooked and undertreated) injuries in all of sports is the ankle sprain. There are far too many examples to discuss but overall they are usually dismissed and played through. An ankle sprain is a partial (or complete) tearing of the ligaments in the ankle, which causes instability of the joint that is already poorly designed for stability. A minor sprain is fairly stable and can heal quickly, allowing a safe return to activity in a matter of a few weeks. However, a major sprain, where more than one ligament is damaged, can lead to chronic instability in the joint which can been career ending.
A specific type of major ankle sprain is the high ankle sprain. In a high ankle sprain, the ligament that holds the two leg bones together (the tibia and fibula) is torn which causes them to spread apart, leading to severe instability. In some cases this needs to be surgically repaired but at minimum needs to be treated with a boot or cast and non-weight bearing for several weeks. If left untreated, a high ankle sprain can lead to early arthritis, chronic pain and can end careers. A great example of this was Rob Gronkowski, the leading tight end in the NFL in 2012 when he tried to play through a high ankle sprain and said they “aren’t easy to shake off”. Read more here: http://www.cbssports.com/nfl/story/17043284/gronkowski-says-hell-play-but-high-ankle-sprains-arent-easy-to-shake-off
Whether you are a professional, college, high school, middle school or little league player, these injuries can affect your game and should be promptly and professionally treated. The doctors at advanced foot and ankle center have extensive education and experience in treating athletes at all levels from elementary school to the pros. Call for an appointment today!
Eric Silvers, DPM, FACFAS
Robert Hadfield, DPM, AACFAS
Dustin Lloyd, DPM, AACFAS
Washington Redskins all-pro defensive back DeAngelo Hall accidentally gave his orthotic away along with his cleat to a young fan after a practice session. He realized when he began his next practice that his feet didn’t feel right and he was having pain. He took to Twitter to find the fan, who happily sent the orthotic back and in return the lucky fan got a game-worn jersey. Hall tore his Achilles tendon last season and has since used custom orthotics which have helped him a lot.
Most professional athletes wear custom orthotics to optimize their performance and help prevent injuries in a variety of sports including: football, baseball, basketball, hockey, track and field, lacrosse, tennis, distance running, figure skating and many more.
The doctors at Advanced Foot and Ankle Center have extensive training and experience making custom orthotics. No matter what your sport, we can help make a difference in your performance and reduce your pain. Call for an appointment today!
Plantar Fasciitis is the medical term for inflammation of the plantar fascia which is the long band of tissue that runs from the heel to the ball of the foot. Many times patients complain of pain in the heel or arch with the first steps in the morning or at the end of the day after activity. Important treatments for this heel pain are proper shoes with orthotics to improve your foot’s function and stretching. Typically, we have very tight muscle groups and this can lead to plantar fasciitis. In this blog we will discuss some of the common stretching exercises to improve flexibility and hopefully kick your plantar fasciitis goodbye.
1- Towel Stretch
- Sit on the floor with your legs strait out in front of you.
- Loop a towel or theraband around the ball of your foot (it’s important to stretch on both even if only one of your feet are hurting).
- Pull the towel towards your nose keeping your back strait up without leaning forward until a stretch is felt across the bottom of your foot and up your calf.
- Hold for 30 seconds then relax and repeat 10 times on each foot.
- Perform this stretch at least twice a day.
2- Wall Stretch (This is my favorite and try doing multiple times throughout the day)
- Stand facing a wall about 2 feet away and place your hands straight out on the
- Take a step back with your affected foot keeping your heel flat on the floor.
- Move the other leg forward and slowly lean into the wall.
- Stop when you feel a stretch through the calf.
- Hold for 30 seconds then relax and then alternate to the opposite foot to stretch.
- Perform this stretch 5 times on each foot.
3- Step Stretch
- Stand with the balls of your feet on the edge of a step holding the railing for balance and your heels off the step.
- Slowly lower your heels until a light stretch is felt. (This stretch is easy to do too much so it shouldn’t be very painful.
- Hold for 30 seconds then relax and repeat 5 times at least twice a day.
4- Water Bottle Roll
- Roll your bare foot back and forth from the tip of the toes to the heel over a frozen water bottle.
- Repeat multiple times in both direction
- Keep the ice water bottle on the painful heel for 20 minutes after performing the stretch.
These 4 stretches are just the beginning to ridding yourself of plantar fasciitis. Each one of these is not a quick fix and consistency is the key. You can never stretch too much. Many times simple stretching does not provide complete relief of your pain. To be fully evaluated and make sure you really are dealing with plantar fasciitis we advise you to make an appointment with one of our plantar fasciitis experts to help resolve your heel pain and get you back to the activities you love. Call today 972-922-6943 for your complete evaluation to see Dr. Silvers, Dr. Hadfield, or Dr. Lloyd.