What If Your Toenail Doesn’t Actually Have Fungus?
Sometimes toenails may be thick, yellow or green, disfigured, and have debris or “build-up” under the nail plate. Usually, my first instinct is to think nail fungus. However, you would be surprised how often that fungus is not the culprit.
At Advanced Foot & Ankle Center, nail specimens are sent to a lab for analysis to determine of fungus is present in the toenails. This is done to prevent you, the patient, from taking unnecessary antifungal medications and other products that are necessary.
So the big question is…….what is causing this? Well, there are many things that cause they same symptoms as nail fungus and I will explain the more common problems.
1. Onychauxis
- this can manifest as thickening or “hypertrophy” of the nail plate. This is usually treated with a medications that decrease the amount of keratin (the substance that makes up nails and hair). Usually urea-based products such Keralac Nail Gel with 50% urea is utilized.
2. Psoriasis
- Nails can have pits (like a miniature ice cream scoop taking divots out of the nail plate.). Nail can have oil spots or brownish-yellow discolorations of the nail plate.
3. Lichen planus
- Nails can have longitudinal ridging, irregular pitting, nail plate splitting, nail loss and thin brittle nails.
4. Reiter’s Disease – rare
5. Pachyonychia Congenita – rare
6. Darier’s disease
- longitudinal ridging as well as red and white longitudinal streaks. The distal nail edges may have V-shaped notching and thickening under the distal part of the nail.
7. Norweigen Scabies - rare
8. Subungual exostoses
- an bone spur can push up into the nail causing a big “hump” in the nail plate and cause the nail to grow awkwardly
9. Melanoma or cancer
- Melanoma and other types of cancer such as carcinomas can manifest different ways. Usually increased pain inthe nail with dark pigment changes are common.
2010 Fall Runner’s Shoe Guide
As the summer begins to cool down and fall begins, running outside will be more tolerable. Make sure you have the proper footwear for running outside.
The following link provides a guide for the best running shoe for Fall 2010.
Fall 2010 Running Shoe Guide
Click the link above
Stress Fractures
A stress fracture is an injury caused by overuse. When the muscles in the foot become tired, they cannot absorb shock as well. In result, the bones begin to absorb the stress of the body weight and can break or crack. Stress fractures usually occur from repetitive activities performed on hard surfaces, or from wearing non-cushioned footwear as well increased duration of physical activity.
Most stress fractures of the foot occur in the metatarsals. Activities such as running on pavement, treadmills, marching in the military or in band practice can all stress fractures. Even falls from heights can predispose someone to a stress fracture. Athletes are the most common to get stress fractures.
Women become more likely to get stress fractures as they age due to the overall decrease in bone mass as compared to men.
Usually stress fractures only hurt with activity. Once the person gets off their feet, the pain oftentimes goes away.
Stress fractures are usually diagnosed with x-rays. Usually sign of a stress fracture show up approximately 10-14 days after the initial injury. So don’t be surprised if nothing is seen on xray shortly after the injury. Sometimes MRI or CT scan is needed to validate a stress fracture when not clearly seen on x-ray.
The best treatment for stress fractures is rest. Stress fractures take approximately 2 months to heal. If someone with a stress fracture begins aggressive activity on the hurt foot too early, they may predispose themselves to a severe fracture which would involve surgery to correct.
To prevent stress fractures, it is important to maintain a healthy diet, use proper shoegear, and give yourself a chance to rest after prolonged workouts. Also, increase activity gradually. You will get into trouble if you try to do too much too quickly.
I>f you think you have a stress fracture, but aren’t quite sure, please contact a podiatrist, such as Dr. Kory Williams or Dr. Eric Silvers. At Advanced Foot & Ankle Center, we are professionally trained in handling these injuries and providing you with the best care in all of DFW. Please call 972-542-2155 for an appointment today.
Calluses
Calluses are thickened areas of the skin formed by friction or rubbing and pressure. Things that often put pressure on the feet to form calluses are shoes or socks, but also activities such as prolonged walking or running. Calluses vary in shape and size and can oftentimes become very painful.
I personally tell patients to avoid cutting or trimming the calluses themselves. Patients should avoid using razor blades, scissors, or knifes to cut calluses. If the foot gets cut, infection can enter the foot and cause more problems than intended.
Usually there is a reason why people get calluses. It may be from an ill-fitting pair of shoes, a bony prominence, or some other condition. Please allow Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot and Ankle Center evaluate your feet, determine the underlying cause and trim your callus or calluses safely.
Please call 972-542-2155 to make an appointment now!
~Dr. Williams
Complex Regional Pain Syndrome / Reflex Sympathetic Dystrophy Syndrome
Complex Regional Pain Syndrome (CRPS) is a disease characterized by pain that is seemingly out of proportion and dysfunction of the nervous system. This rare syndrome can be caused by trauma and even surgery. It is a very unfortunate occurence.
The pain CRPS is said to be burning in nature, knife-like, sharp or stinging, and is caused by the slightest touch or movement. Sometimes the blood vessels are affected in which the arteries and veins constrict causing whiteness and duskiness of the skin as well as causing a bluish-gray discoloration. Also the sweat glands are affected causing intermittent episodes of perspiration followed by extreme dryness of the skin. Swelling of the affected limb can occur and fluctuate.
Stages of CRPS
Stage 1 (1-3 months) – The foot is swollen, soft an puffy. Increased pain and hypersensitivity to touch is noted. Increased sweating noted.
Stage 2 (3-6 months) – Very swollen and skin is tight. Range of motion in the joints is limited. Loss of muscle tone noted. The skin is mottled and blue/gray.
Stage 3 (6-9 months) – The foot is cool and dry with a white discoloration. The skin is taut, waxy and thin. Stiffness of the joints is noted.
Other causes of this disorder include nerve injury, fractures, sprains and crush injuries. A person may have an increased susceptibility if they have sweating of the palms in the winter, cold insensitivity, and an intolerance to pain.
Treatment must be performed very quickly upon diagnosis. Consultation with a pain specialist, neurologist, or anesthesiologist is warranted whenever suspicion arises.
Treatment includes nerve injections, anti-depressants, anti-inflammatory medications and counseling. Sometimes spinal injections are performed.
It is thought to perform motion exercise and other forms of physical therapy is needed. Avoidance of immobilization is necessary.
This problem is very serious and can be quite debilitating. If you have this condition please contact Dr. Eric Silvers or Dr. Kory Williams at Advanced Foot & Ankle Center so they may orchestrate a team approach to remedy the situation as soon as possible.
Gout
Gout is caused by increased uric acid in the body. Uric acid can accumulate so much that it form into large crystals an get deposited into joints and tissues.
There are basically 2 ways people develop gout:
1. Metabolic Gout: Every person has a “factory” inside their body that makes uric acid. If the “factory” works too hard and too much uric acid is produced, excess uric acid is then redistributed by the blood to the joints and soft tissues. Diets that have a high purine content is usually the primary cause for this particular type of gout.
2. Renal Gout: If a person has normal “factory” and produces a “normal” amount of uric acid, but the kidneys can’t pee the uric acid out fast enough, then uric acid can accumulate in the body. Primary renal gout is usually due to kidney disease but can also be due to diuretics.
There are basically 2 forms of gouty arthritis:
1. Acute Gouty Arthritis: This type of gout usually affects one joint, has a sudden onset and very painful inflammation. The joint is red, hot, swollen and has excruciating pain. The joint is often stiff and oftentimes the joint is so painful the sheets can’t touch it.
2. Chronic Gouty Arthritis: In this type of gout, people can develop collections of uric acid crystals called tophi or a tophus. These tophi can be deposited in the soft tissues, ligaments, tendons and joints. Sometimes the tophi can poke through the skin and drain a white chalky substance resembling cottage cheese.
The most common areas for gout to manifest are in the great toe joint, the back of the heel where the achilles tendon inserts, the ankle, hand, wrist, elbow and knee.
Treatment of Gout
Medications often used treat gout are the following:
1. Indomethacin – for acute gout inflammation
2. Colchicine – for acute gout inflammation
3. Allopurinol – for people who overproduce uric acid
4. Probenecid – for people who underexcrete uric acid
5. Sulfinpyrazole – for people who underexcrete uric acid
If you think you may have gout and want to have it checked, please come see Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney and Prosper, TX. Call 972-542-2155 for an appointment.
~Dr. Williams