How do you know when it is time for new shoes?

In general most running and walking shoes will last an average person about 300-400 miles.  This is a very difficult concept of mileage as someone that wears gym shoes on the weekends and not specifically for running or walking.  These numbers can change based on foot deformities, walking or running gait patterns, your weight, and terrain.  Walking on pavement will wear down the shoe faster than walking on a track or grass.  So how can you tell when it is time to retire your shoes to the recycler?

  • Examine your shoes! Don’t worry about how dirty they are but pay attention to the different parts of the shoe that help it help you walk comfortably.  Is the material around the heel getting worn or torn?  When you press the heel opening is it still sturdy or does it collapse under pressure?  Does the tread on the bottom of your shoe match the whole length of the shoe or are there areas that are worn down?  This will force your foot into an incorrect position potentially causing pain.  If the shoe looks like it is molding to your foot it is time to go!
  • Pay attention to how they feel on your feet! If you are noticing new aches and pains in your feet, knees, hips or back directly or the day after wearing your shoes it is probably time for a new pair. If you are getting blisters or areas of irritation it is a sign of the need for a new pair of shoes or the shoes you have are improperly fitting.  You should never have to “break in” a pair of running or athletic shoes.
  • Do the twist and push test! In general when purchasing a good pair of athletic or running shoes you should twist them like a dish rag and they should be solid and you should push on the bottom of the sole and look for slight compression with wrinkling of the edges of the shoe.  If your shoes have become very flexible with the twist test and when you push they have no ability to compress at the sole it is time for a new pair.

Shoes are so important for proper foot health.  If you have low arches or high arches shoes are not made to support those.  It may feel like there is arch support in a new pair of shoes but when you pull out that flimsy insole in that shoe it is flat like the floor on the inside.

When you perform those tests above and decide to get new shoes remember you are getting new shoes because these are worn out.  That doesn’t mean to transfer your worn out shoes to become your mowing shoes.  Just think if they may potentially cause you pain and problems on level surfaces mowing on unleveled yard pushing a mower is not going to be good for your feet in those old pair of shoes.

In general you get what you pay for to some extent with shoes.  However paying for a certain brand or paying a certain price does not always mean that will be the right shoe for your foot or it is worth the price.

At Advanced Foot and Ankle Center in McKinney and Prosper Texas our goal is to keep you moving doing the things you love and shoe gear is a big part of that.  We have The Foot Store located within our McKinney office which has comfortable and stylish shoes for your time at the gym, at the office, or on the weekend out with friends.  If there is not a shoe that is appropriate for you and your condition in The Foot Store we will make the recommendation on the best shoe for you.  Call today 972-542-2155 to make an appointment and be evaluated by one of our foot and ankle specialist, Dr. Silvers, Dr. Hadfield or Dr. Lloyd, or just stop by and try on your next pair of shoes in The Foot Store.

Why Are My Feet Swollen?

Why Are My Feet Swollen?

 

There are a number of causes of swelling in the feet and legs and many of them are not as bad as you might think.  The most common causes of swelling are chronic health issues and, if treated correction, the swelling doesn’t pose a serious health risk.  The most common causes of swelling in the feet and legs are peripheral vascular disease (PVD)/ varicose veins, water retention due to kidney issues, congestive heart failure, arthritis, tendinitis, chronic joint diseases (such as rheumatoid arthritis), injuries and surgery.

The vein network in the lower leg, ankle and foot is unique and works differently than other parts of the body.  This anatomic difference, along with gravity, is the cause of many of the types of swelling.  This difference is in the system which returns blood to the heart.  There are two systems of veins that return blood to the heart: the superficial and deep systems.  In the rest of the body, the deep vein system is the main way the blood is returned, but below the knee it is the superficial system (the veins that are visible). Inside these veins are valves, which keep blood from flowing backward due to gravity.  The valves are vital to the proper function of the veins.  This different pathway of blood return is central to the problem of swelling in the foot and ankle and when there is damage to these veins the result is peripheral vascular disease (PVD).

The most common cause of swelling in the feet and legs is peripheral vascular disease (PVD).  The most common cause of PVD is high blood pressure over the course of several years.  A chronic increase in blood pressure causes damage to the arteries and veins, leading to thickening and hardening of the walls of the arteries and damage to the valves in the veins.  Hardening of the arteries is called atherosclerosis and creates increased pressure on the veins, which causes them to dilate (swell).  When the veins dilate, the valves inside of them no longer work correctly.  This causes pooling of blood in the legs and feet, leading to chronic swelling.  Varicose veins result from this chronic pressure.

If severe and untreated, chronic swelling in the legs and feet due to PVD can cause issues, including venous stasis dermatitis (which is a rash) and venous ulceration (which is an open wound on the leg).  The first line of treatment, and often the best, is compression stockings, which help create pressure against the dilated veins to help them do their job better, clearing out the chronic swelling.  There are some procedures, which are performed by a vascular surgeon, which can help with severe PVD including scerlosing injections and laser vein ablation.   These procedures can help improve chronic swelling due to PVD.

Water retention is another common cause of chronic swelling in the legs and feet.  This condition is usually due to kidney issues.  The kidneys are responsible for removing wastes from the body, but also serve an important function in regulating the amount of fluid in the body.  When the kidneys are not functioning as they should, too much fluid is retained in the body.  The body’s response to this is to deposit the fluid in the legs to get it out of the blood stream.  The swelling that results is called “pitting edema”, and this name is given because when the skin is pressed with a finger, a dent will stay in the skin for a few seconds, creating a “pit”.  The treatment for this type of swelling is aimed at helping the kidneys function better to remove the fluid.  Compression stockings are also helpful.  A kidney specialist (nephrologist) is an important part of the process for best results.

Congestive heart failure is another common cause of leg and foot swelling.  This is caused by a variety of factors, many of which are genetic but high blood pressure plays a big role as well.  In congestive heart failure, as in kidney disease, there is too much fluid in the blood stream and so it is deposited in the legs and feet to get rid of it.  This kind of swelling is also “pitting edema”.  Treatment is very important and a cardiologist is the right specialist to handle this type of condition.  Compression stockings can also be helpful in this case but care must be taken to use them under the supervision of a cardiologist.

Chronic joint and tendon problems can also lead to swelling in the feet and legs.  This can be a chronic or acute condition.  One of the big hallmarks of arthritis in all its forms (osteoarthritis, rheumatoid arthritis, psoriatic arthritis, reactive arthritis) is swelling around the affected joint.  Swelling in these cases is caused by the inflammatory process, which your body uses as a defense mechanism, much like during a fever during a viral illness.  The problem in arthritis is that the inflammatory process is trigged by a misinterpretation by your body of a disease, especially in cases such as rheumatoid arthritis, where the immune system tells the brain that normal parts of the joints are foreign invaders and must be killed.  Rheumatoid arthritis is an example of an autoimmune disease, meaning that the immune system attacks the body’s normal tissues because it is confused and thinks they are going to hurt the body.  Other examples of autoimmune diseases are Psoriasis, Crohn’s disease, Lupus and Parkinson’s disease.

Both Psoriasis and Crohn’s disease are ones that can cause chronic swelling in the feet and legs.  In Psoriasis, the body attacks the skin, but it can also attack the joints of the foot, most commonly the toe joints and cause a “sausage digit”, which as the name sounds is severe swelling in the toes.  Swelling due to Crohn’s disease is known as reactive arthritis.  The immune system in this case attacks the intestines but can also cause chronic arthritis, leading to swelling.

Injuries and surgery to the foot and ankle can cause significant swelling during the initial (acute) phase.  Swelling in these cases is usually accompanied by bruising, pain and inability to walk.  Much to the chagrin of most people, the swelling is usually the last symptom to go away when the injury or surgery is healed.  The bones and/or ligaments and tendons heal but the swelling remains.  Veins die, are reabsorbed and re-grow constantly in the body as part of normal maintenance.  When many are disrupted as part of the injury or surgical process, the vein network must be repaired and this takes on average 6 months to return to normal.  Swelling in this case, in the absence of pain, is not something to be concerned about and will resolve in almost all cases.

No matter the cause, new swelling should be investigated to find the underlying cause.  If properly treated, all forms of swelling can be improved.

The doctors at Advanced Foot and Ankle Center have comprehensive training in all forms of foot and ankle conditions and are here to serve you.  Please call with any questions you may have.

 

972-542-2155

 

Sincerely,

Eric Silvers, DPM

Robert Hadfield, DPM

Dustin Lloyd,DPM

We are here for your Second Opinion

The relationship between a patient and their doctor is one of mutual trust and understanding.  At times during the course of treatment you may have questions about your diagnosis or the recommendations that your physician has given you.  Many times you may want to be seen by another physician for a second opinion.  At Advanced Foot and Ankle Center in McKinney and Prosper Texas we understand second opinions are a part of an individual becoming engaged in their healthcare.  We welcome those seeking a second opinion.  No matter how big or small the condition may seem.  If you have questions and would like another set of eyes to ensure the diagnosis and treatment are correct please call and make an appointment today.  Most times same day appointments can be accommodated.  With convenient offices in McKinney and Prosper we are just a short drive from all North Dallas Suburbs.  Drs. Silvers, Hadfield and Lloyd are committed to provide you with the highest quality care and the most current and advanced treatment options.  We practice with a conservative treatment first approach to try and prevent the need for surgical intervention if possible.

Call our office today to schedule your appointment at 972-542-2155.

Take your step in the right direction to Advanced Foot and Ankle Center.

Top 10 Pediatric Foot Conditions

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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

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

It’s Getting Cold Outside!

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.

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To make an appointment call
(972) 542-2155


McKinney Office
5531 Virginia Parkway
Suite 100
McKinney, TX 75071


Prosper Office
301 North Preston Road
Suite A
Prosper, TX 75078


McKinney Office
5531 Virginia Parkway
Suite 100
McKinney, TX 75071

Prosper Office
301 North Preston Road
Suite A
Prosper, TX 75078

(972) 542-2155

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