- Glass, splinters or other foreign objects in the foot.
- Cuts that need stitches.
- Broken bones in the foot and ankle
- Ankle and Foot sprains
- Ingrown Toenails
- Foot Infections
Wounds in Diabetes
Wounds are one of the most concerning problems in diabetes and can lead to serious complications including infection, amputation and loss of life. These wounds can begin very small and get larger very quickly, leading to an increased risk of infection.
Patients with diabetes are at an increased risk for wounds for many reasons. High blood sugars cause damage to the nerves and blood vessels in the body, leading to a condition known as neuropathy. Neuropathy symptoms range from tingling and numbness to burning pain or sharp pain at times. Numbness all the time is a common feature of neuropathy, and it is this part that causes an increased risk of developing a wound. When a person cannot feel their foot, there is no protective nerve sensation that tells them that something is wrong and needs attention. This causes the wound to become larger and deeper before treatment begins. Pressure, cuts, blisters and stepping on objects are the main initial causes of a wound.
Patients with diabetes are also at higher risk for infection because high blood sugars cause issues with the immune system. Having an open wound, combined with a decreased ability to fight infection are a difficult combination and can cause serious issues very quickly.
Healing Is Difficult
Patients with diabetes also have a decreased ability to heal. High blood sugars and high blood pressure cause damage to the blood vessels which leads to decreased circulation in the feet. The cells that heal the body are carried through the blood stream and so blood flow is very important for the healing process.
Treatment of Wounds
Treatment for diabetic wounds consists of removing the excessive tissue to stimulate the body to heal, use of specialty products to improve wound healing and various wound creams. This process can take an extended period of time in many cases, making prevention very important. In all cases, reversing the cause of the wound is vital to success.
Treatments for Neuropathy
There are treatments for neuropathy, including both topical and oral medications. There are creams and foams that help improve the burning pain. There is a product, called Neuremedy, which helps replenish the nutrients the nerves need for proper function. There are also prescription medications, such as Neurontin and Lyrica, which help to improve the burning pain and numbness. Discussing these treatments with your doctor is important to select the proper treatment for you. Improving neuropathy greatly decreases the risks of developing wound and can help in the treatment of a wound as well.
Treatments for Circulation
As discussed before, reversing the cause of the wound is vital to the healing process. If circulation is poor, wound healing is very difficult. In many cases, seeing a blood vessel specialist to improve blood flow is important. There are many options they can provide to help the circulation.
Methods of Prevention
The most important points in proper diabetic foot care are to do daily inspection of the feet, avoid moisture between the toes, keep blood sugar and blood pressure under good control and wear diabetic shoes. Diabetic extra depth shoes are important for those with neuropathy and diabetes to help prevent wounds from forming. The foot bed within the shoes helps to decrease pressure on the bottom of the foot, helping to eliminate one of the leading causes of wounds.
In summary wounds in patients with diabetes are a very serious and an increasingly frequent problem in the United States. With proper care and maintenance, they can be avoided and appropriately treated when they occur.
The doctors at Advanced Foot and Ankle Center are highly trained and experienced in the treatment of all complications of diabetes in the foot including wounds. Call for an appointment today.
Eric Silvers, DPM, FACFAS
Robert Hadfield, DPM, AACFAS
Dustin Lloyd, DPM
Toenail fungus is a common problem and can happen to anyone. It is characterized by thickness, discoloration, darkness, brittleness and/or flaking of the nails and the big and little toes are most commonly involved. These issues can become worse over time if not treated and can lead to a fungal infection of the skin as well (athlete’s foot).
Fungus is a slow growing organism that thrives in a warm, moist and dark environment and shoes, especially closed toed shoes, are a perfect place for it to reproduce. Most people with a healthy immune system fight off fungus and prevent infection of the nails. However, people with a compromised immune system, such as those with diabetes, HIV, poor circulation, cancer and those taking certain medications, are at increased risk for nail fungus.
The most common cause of contracting fungus is from trauma to the nails, which opens an avenue for fungus to get in. This doesn’t have to be from dropping something on the toe. It can be from repetitive small traumas, such as wearing tight shoes, certain walking patterns that increase the pressure on the big toenail and pedicures. The fungus lives deep at the base of the nail and infects the nail as it grows out making it necessary for treatment to get deep to the root.
Fighting toenail fungus has proven very difficult. It is hard to contract, but once fungus gets inside it is very difficult to get rid of. However, there is hope. There are many treatments available, including over the counter and prescription topical medications, prescription oral medications, laser therapy and total removal of the toenail. Each of these treatments can be effective against nail fungus depending upon the type of and severity of the fungal infection. Having your nails evaluated by a podiatrist is important to select the proper treatment for you.
Topical medications have been shown to be effective in fighting nails that are partially or more superficially infected. There are prescription nail polishes and creams that can help slow the growth of the fungus and improve the health of the nail. Topical medications are advantageous because there are little to no side effects or risks.
Oral medications are very effective in treating nail fungus and the most common one used is Lamisil. Lamisil has been shown to be very effective in treating more severe types of nail fungus, where the entire nail is involved and the infection has been present for a long period of time. Lamisil does carry risks of liver damage, however, and patients must be closely monitored.
Laser therapy is a relatively recent treatment for nail fungus but has been proven effective. The laser kills the fungus using light waves that destabilizes its ability to live and reproduce. The laser therapy is painless, is fast to administer, and has similar effectiveness to other treatments. This modern technology has helped many patients, without the health risks associated with other nail fungus treatments.
With all treatments for nail fungus, patience is a virtue. It takes 9 months to a year for the nail to see full resolution of the fungus, because it takes that long for the nail to grow from the root all the way out to the end. It is similar to dying your hair and waiting for it to grow out. The nail is damaged by the fungus and that damaged nail must grow off and new healthy nail replace it.
The doctors at Advanced Foot and Ankle Center have significant experience in all forms of treatment for toenail fungus. Call for an appointment today!
Eric Silvers, DPM, FACFAS
Robert Hadfield, DPM, AACFAS
Dustin Lloyd, DPM
Turf Toe is a sprain of the ligaments around the big toe joint. It is not a condition any football, soccer or other sports coach ever wants to hear their player has.
How does Turf Toe Occur?
Most commonly turf toe occurs when athletes play on artificial surfaces. It can, however happen to any athlete participating in other sports including cheerleading, dance, soccer, wrestling and gymnastics as well as others. It is caused by the jamming of the big toe or repetitive pushing off of the big toe when running, jumping, or cutting. The big toe is hyperextended moving past its normal range of motion causing ligaments to become sprained. A major risk factor in Turf Toe is wearing athletic shoes that are too flexible as well as shoes that do not provide appropriate support for the foot structure.
Symptoms include pain and tenderness in the ball of the foot especially around the big toe joint. Commonly an athlete will be unable to push off of the big toe due to the pain or discomfort. Athletes are sometimes unable to bear weight on the ball of the foot due to the pain. Typically immediately after the injury occurs swelling and bruising are seen around the big toe joint. Turf toe is an injury that potentially can keep an athlete out of participation in sports for 2-6 weeks.
At Advanced Foot and Ankle Center, Drs. Silvers, Hadfield and Lloyd will work with the athlete to get them back into their sport.
Treatment consists of wearing a stiff soled walking boot to decrease the motion through the big toe joint and allow healing to occur. The use of ice, resting the foot, as well as prescription anti-inflammatory medications are also typically utilized. There are advanced taping techniques that may be performed to stabilize the big toe joint as it heals. Advanced Foot and Ankle Center also offers class 4 K-Laser therapy to help decrease inflammation and pain on order to help the athlete get back into their sport. At times advanced imaging is required to determine the extent of the injury with the use of X-Ray or MRI. In some cases when a bone has been broken during the injury or if there is a complete rupture of the ligaments; the best option to reduce the chances of long term adverse effects is surgical correction of the injury. This is reserved for only the most advanced cases. An injured athlete when treated after the initial event will typically be able to return to their sport with the use of the conservative non-surgical treatments discussed above.
If your athlete has a sports related foot or ankle injury, call our specialists at Advanced Foot and Ankle Center in McKinney and Prosper Texas at 972-542-2155. We offer early morning, lunchtime, and evening appointments. We look forward to providing you with a high standard of care and compassion.
With summer in full swing in North Texas sandal season is at its peak. We at Advanced Foot and Ankle Center understand that a good pedicure lets you show off your beautiful toes. Dr. Silvers, Dr. Hadfield and Dr. Lloyd would like to offer some advice on how to choose that perfect salon.
It’s important when you go into a salon to not be afraid to ask questions. Here are some guidelines to follow at your next pedicure appointment:
- Make sure that they are using an autoclave to clean their instruments after every client. The autoclave uses high heat and steam to make sure all bacterial and fungal spores are killed.
- Make sure that they have cleaned and disinfected the chairs as well as run the disinfectant through the jet system.
- Don’t let the nail technician dig into the corners of your toenail to remove the nail. This may allow bacteria to enter the nail fold causing an infected ingrown toenail.
- Bring your own polish with you to your salon appointment.
All of these will help prevent the chances of getting a bacterial or fungal infection.
Dr. Lloyd reminds you that nail polishes at salons are used on many different clients therefore no matter how clean and sanitary the salon is; there is no way to clean the polish brushes in the polish bottles. At Advanced Foot and Ankle Center we offer a line of polish that was developed to improve nail health. Nourish Organic Enriched Nail Lacquer contains Lemongrass, Thyme and Tea Tree Essential Oils that contain natural anti-fungal properties as well as Vitamins C and E to help promote healthy nail growth. Nourish Nail Lacquer is also toxic free which means No Formaldehyde, No Toluene and No DBP which are found in many other polishes on the market.
If you notice thickening, discoloration or changes to your toenails schedule an appointment with Dr. Silvers, Dr. Hadfield, or Dr. Lloyd at 972-542-2155 or visit us online at www.advancedfoottexas.com
We have offices located in McKinney and Prosper, Texas. We offer early morning, lunchtime and evening appointments.
Do you suffer from chronic ankle pain? Ankle arthroscopy may be the answer for you!
Ankle arthroscopy is a minimally invasive procedure that helps to clean out the tissues and fluid that create the inflammation, which causes the pain. The procedure takes about an hour and is outpatient surgery. The recovery time is very short (in most cases you can walk in 3-4 days) and the results can be much longer lasting than a steroid injection or pain medicine.
What Happens During the Procedure?
Using a small camera and instruments inserted through tiny incisions, the ankle joint can be inspected and many causes of ankle pain can be repaired. These causes include synovitis (inflammation of the lubricating tissues), damage to the cartilage, loose pieces of bone, damaged ligaments and bone spurs. Each of these problems can be effectively treated with ankle arthroscopy, helping to reduce pain and improve mobility.
What Needs To Be Done First?
An x-ray and/or an MRI, as well as a physical exam by a foot and ankle specialst, are necessary to see if you are a candidate for ankle arthroscopy. The doctor will explain the goals, expected benefits, complications and alternatives during this visit. In most cases, arthroscopy of the ankle is a low risk and high reward procedure that can quickly and effectively decrease ankle pain and get patients back to their desired activities. Depending on the reason for the ankle pain, the recovery period can be short or a little longer and proper workup is important to determine the prognosis.
What Is the Recovery Like?
Again it depends on the extent of the procedure but in most cases patients only need to be on crutches 3-4 days and usually can go back to work after that time if they work at a desk. If work requires a lot of walking or heavy lifting, 2-3 weeks may be needed before a return to work.
How Much Pain Will I Be In?
Pain medication is usually needed for 3-7 days following the procedure, depending on the extent of the procedure and a person’s pain tolerance. In most cases, the pain is improved compared with before the surgery in about a week.
The doctors at Advanced Foot and Ankle Center are well versed in all forms of ankle arthroscopy and would love to assist you in improving your ankle pain. If you would like more information about ankle arthroscopy please call our office at 972-542-2155