Bunions are a very common foot deformity. However, 90% of people make themselves suffer for years before seeking any treatment for them. Why suffer when you can get them treated now!

What is a Bunion Anyway?

The fancy, scientific name for a bunion is called hallux abducto valgus. I know, a big, hard-to-say name, but that’s what it’s called. Bunions are a big, bony lump on the inside of the foot by the big toe. The big lump is actually a change in the bony architecture in the front of the foot. The big toe tends to lean on the 2nd toe instead of being straight and erect. The bone behind the big toe (called a metatarsal) leans in the opposite direction, causing the lump on the inside of the foot.

Bunions get worse over time. The bump on the inside of the foot gets progressively bigger and the big toe leans even more on the 2nd toe and even the 3rd toe, bulldozing the toes out of the way. Bunions usually do not hurt until the deformity is really bad and that is when those people show up at our office wondering what to do.

Causes of the blasted Bunions

Of all the things that can cause bunions , my expertise tends to believe bunions are more hereditary than anything else. Look at Mom or Dad, or Grandma and Grandpa. If you have a bunion, I would put good money on the fact that they probably have one too. This inherited faulty architecture is unlucky, but don’t fret…..there is treatment.

In addition to genetics, you can also force yourself to have  a bunion. You’re probably thinking, “How in the world can I make myself have a bunion?” Well, it’s pretty easy if you are not careful. Pointed-toed shoes are a big cause of bunions. It doesn’t have to be only high heeled shoes. Pointed cowboy boots and tight sneakers can also cause bunions. Most people find out that if they just find some wider shoes, their bunion pain disappears. It’s magic!

So if I have a bunion, what is it supposed to feel like?

You would be surprised. I have a tons of patients with terrible bunions who have no pain. No pain! You would think with having this huge lump on the inside of the foot, and the big toe cocked sideways, they would have some sort of pain. Guess what ladies and gentlemen, if I fixed every bunion that walked through the door, I would be in surgery all day, every day. So this is what I tell people with non-painful bunions: Your bunion will worsen. It will get bigger with time. If you start to develop arthritis in the big toe joint and the bone gets soft, it may be too late to get the procedure you need. Bone needs to be hard for screws and hardware to stay in place. So it is better off to fix a bunion earlier than later.

However, symptoms you might have are as follows:

1. Pain

2. Redness or inflammation

3. Burning in the joint

4. Numbness or tingling

Most of the time, symptoms occurs in tight shoes. Tighter the shoe = more bunion pain. This is probably why most ladies have more pain than men. Also, if you have a job where you stand most of the day, bunions can become very irritated.

So how do you diagnose a Bunion?

Diagnosis of a bunion is usually made right after you take off your sock. It is pretty easy to recognize, but knowing what to look for is key. Some patients have huge bunions and I say, “WOW! that’s a big bunion!” and the patient says, “What? Is that what that thing is?” I know that sounds crazy, but seriously folks, it happens.

I usually take x-rays to examine the bunion. I measure all the angles and can mathematically calculate which bunion procedure would be best for you.

How can you treat bunions without surgery?

I will be honest and say THERE IS NO CONSERVATIVE TREATMENT TO CORRECT YOUR BUNION!

Yes I said that. What you have is what you have. I cannot do anything non-surgically to correct your bunion, but we can slow the progression of it.

Things that might help you achieve a pain-free bunion without having surgery are listed below:

1. Padding – Our office, as well as every pharmacy in the United States, carries a truckload of pads for bunions. They range from gel to foam to felt.

2. Wider shoegear – Choose shoes with a wide toebox. High heels and pointed cowboy boots are gonna kill your feet if you don’t try and change.

3. Activity Modifications – Try not to stand so long. Harder to say than do, but try if you can.

4. Medications – There are medicines out there that I can prescribe or you can take over-the-counter to decrease the inflammation in the bog toe joint.

5. Ice therapy – Nothing like a good old-fashioned ice pack to decrease some inflammation.

6. Injection therapy – Nobody like shots, but a small dose of steroid can do a joint good when the inflammation is making your life hard.

7. Orthotics – a custom shoe insert is an excellent and proven method for slowing down the progression of bunions. Of all the conservative therapies, this one, by far, is the best.

What if I tried all this conservative stuff and I am ready to have surgery?

If conservative treatment has failed, and you are at your wit’s end, then surgery is needed. Bunion surgery is very common. There are 75 types of bunion surgeries that can be performed, however, I have my favorites. The type of surgery depends on how bad your bunion is.  I have done surgery on the smallest bunions and the largest, most gnarly bunions you have ever seen. I would personally have to evaluate your bunion to determine which procedure would be the best for you.

Please read the following blog about bunion surgery. I have a listed several things to know concerning surgery. I hope this helps. Have a nice day.

~Dr. Kory Williams

An elderly gentleman presented to our clinic today complaining of itching, burning and drainage between the toes. Patient states his right and left foot have had this appearance for approximately 1 week duration.

The patient stated he had a long history of athlete’s foot, but has never had it this bad. Patient had applying over-the-counter antifungal and hydrocortisone creams in between the toes. Patient stated that his feet actually looked “pretty good” as compared to the past few days.

The patient was ultimately placed on the following medications:

1. Prednisone orally – a steroid to calm down the inflammation of the area

2. Gris-Peg – an oral antifungal taken 3 times per day

3. Augmentin – an antibiotic to fight any secondary bacterial infection

4. Naftin Gel – a topical antifungal to placed between the toes followed by separation of the toes with cotton balls.

5. Betadine – iodine based products to dry out between the toes

Patient was advised to let his feet air dry for 3-4 hours day and use an oscillating fan to “air out” the feet.

Patient is to return in a week for follow-up. More pictures will be posted as this patient continues to improve. Stay posted.

If you have athlete’s foot, please come see the doctors at  Advanced Foot & Center for treatment.

~Dr. Williams

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155

]]> http://www.advancedfoottexas.com/2010/03/a-case-of-athletes-foot/feed/ 0 http://www.advancedfoottexas.com/2010/03/dont-be-fooled/ http://www.advancedfoottexas.com/2010/03/dont-be-fooled/#comments Mon, 22 Mar 2010 20:14:06 +0000 Dr. Williams & Dr. Silvers http://www.advancedfoottexas.com/?p=1202

As I was walking through a Walmart in McKinney buying groceries, I ventured over to the foot product section by the pharmacy. What I saw made me a little disappointed.   I saw this “machine” by Dr. Scholl’s claiming to analyze your feet and prescribe you “custom orthoses”. To the layman, this may seem like a good deal, however, I feel this is very misleading to the consumers.  It must be known that every orthotic sold at Walmart, CVS, Academy Sports, Walgreens are NOT custom orthotics. They are pre-fabricated in a factory.  Custom orthotics are completely different and are manufactured by taking a cast or mold of the feet, sending the mold or cast to an orthotist, who produces an orthotic specific for your feet. The orthotics by Dr. Scholl’s may be something to try initially, but if you continue to have pain, please seek a professional opinion from Dr. Williams or Dr. Silvers. We can provide “true” custom orthotics.

They present with a complaint of pain in the toe, sometimes localised to the nail fold. Sometimes the swelling itself may cause pressure on the shoe. Some have a history of trauma or previous nailbed surgery (which may have been for an “ingrowing toenail’ that was, in fact, the exostosis).

Examination shows a firm swelling under the nail, usually in the medial nail fold. It is usually covered with epidermis, but may be raw or granulating.

The main differential diagnosis is ingrowing toenail, with a nailbed tumour such as melanoma, squamous carcinoma or glomus tumour as a much rarer possibility.

The lesion normally continues to grow so is best removed when diagnosed. This can be done under digital block anaesthesia as a day case. Sometimes the nail fold can be elevated and preserved, but usually it cannot be separated from the lesion and must be sacrificed. Even with careful excision of the whole lesion, the recurrence rate averages about 10%. A few patients require removal of so much nail bed that there is significant post-operative nail deformity, so that plastic nail bed reconstruction may be consdered (Suga 2005).

If you feel you may have a painful subungual exostosis, please see Dr. Kory Williams or Dr. Silvers at Advanced Foot and Ankle Center for treatment.

References

• De Berker DA, Langtry J. (1999). Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140(5): 915-8
• Dalle S e al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-4
• Gray RJ et al. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705
• Lee SK et al. Two distinctive subungual pathologies. Subungual exostosis and subungual osteochondroma. Foot Ankle Int 2007; 28:595-601
• Suga H et al. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg. 2005;55(3):272-5

Madura foot is terrible, destructive infection of the skin and deeper tissues. Oftentimes, the infection can reach deeper tissues such as muscle and bone.

It is noted that different species of fungus or bacteria can cause madura foot.

In the United States, Madura foot is most often caused by an organism called Pseudallescheria boydii. Now that’s a mouth full!

Although Madura foot may occur throughout the world, it is most common in dry, tropical, and rural settings. Therefore, this may not be seen very often in Texas, especially North Texas.

Madura foot is usually painless and has 3 characteristic features:

1. Formation of a nodule or lump at the site where the organism is first received, such as a penetrating injury like a puncture wound.

2. There is noted pus and tunneling into the skin at the site of the wound.

3. There is noted “grains” or “granules” within the drainage.

The infection can cause severe swelling and enlargement of the affected leg or foot. The infection can become painful if bone is involved.

Treatment often involves antibiotics and antifungal medications, but amputation is often the end result.

If you feel you may have Madura foot, please come see Dr. Williams or Dr. Silvers and we can refer to the proper Infectious Disease specialist.

A claw toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. Claw toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe.

Claw toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually.

A rigid claw toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

Cause

Claw toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes.

Treatment and Prevention

Changing the type of footwear worn is a very important step in the treatment of claw toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the claw toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes.

Other conservative treatments include using forefoot products designed to relieve claw toes, such as toe crests and hammer toe splints. These devices will help hold down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

Hammertoe Crest Pad

Gel Toe Cap

Budin splint / Toe Straightener

If you feel you may have clawtoes, please come see Dr. Williams or Dr. Silvers for treatment.

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155

Enjoy! Have a great day!

P.S. – These are not recommended to wear.

~Dr. Williams

Pretty cool.

~Dr. Williams

Click on the link to watch this video: Artifical Foot Prosthetic

Subungual hemoatomas develop because the arteries in the nailbed (the tissue between the nail plate and the bone) get damaged. There is a potential dead space or vacant space that can form between the nail plate and the nail bed, which can fill with blood.

The pressure from the blood under the nail can cause severe pain.

Most patients present with with a swollen toe and complaints of throbbing pain following injury. The 2 most common mechanisms are repetitive microtrauma from sports such as running or tennis or direct trauma from a crush-type injury.

When looking at the nail plate, if the blood takes up more than 25% of the nail plate, then a fracture of the bone underneath usually occurs.

Treatment involves draining of the blood to relieve the pressure. Hematomas involving less than 25% of the nail plate are usually drained by poking a hole through the nail plate with a heated paperclip, a needle, or a hand-held cautery tool. Once the nail plate is penetrated, the blood under the nail is expressed using slight pressure. The area should then be cleansed a dressed with a sterile dressing.

When the blood collection involves more than 25% of the nail plate, there is increased risk of nail bed laceration. Therefore, complete removal of the nail is required in order to properly evaluate the entire nailbed.

Decompression of a subungual hematoma is quick, easy and painless. Patients feel immediate relief and generally have no complications following prompt drainage. Usually the nail will come off on its own in approximately 6 weeks after the trauma, and a new nail is regrown by 6-9 months without being disfigured.

The shortening of the bone is caused by the growth plate pre-maturely closing before growing out to full length. The cause why this happens is still mostly unknown.

Brachymetatarsia is related to following disorders and syndromes:

• Down’s Syndrome
• Turner’s syndrome
• Pseudohypoparathyroidism
• Psuedo-pseudohypoparathyroidism
• Albright’s syndrome
• Diastrophic dwarfism

Bracymetatarsia usually occurs in females and usually occurs in both feet. X-rays usually confirm the shortening of the metatarsal.

As a child, the deformity is usually asymptomatic. The primary complaint in the younger patient is often cosmetic, and many times these patients are self-conscious about their appearance. Older patients may experience symptoms of pain due to excessive pressure under adjacent metatarsal heads. Increased callus formation in the ball of the foot may be present. Skin, soft tissue, and tendon contractions lead to additional discomfort with the use of shoes.

Treatment of brachymetatarsia may include conservative care, such as an orthotic device to take pressure off the adjacent metatarsal heads. Shoe gear may be modified a possible hammertoe deformity or contracture of a toe.

Definitive treatment requires surgical correction to address the soft tissue contractions as well as the shortened metatarsal. Numerous surgical procedures exist to correct brachymetatarsia such as the following:

• Bone Grafts
• Metatarsal osteotomies
• Distraction of the metatarsal with an external fixator
• Tendon lengthening
• Skin modifications

At Advanced Foot & Ankle, Dr. Williams prefers the procedure in which lengthening of the metatarsal is performed with an external fixator. Below is a picture showing the external fixator on the 4th metatarsal bone allowing distraction of the bone.

Please come see Dr. Williams or Dr. Silvers if you have brachymetatarsia and we can discuss your treatment options.

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155