Diabetes Alert Day
The ADA is asking Americans to “Join the Million Challenge” by being tested for the possibility of having diabetes. You can take a FREE Diabetes Risk Test by simply logging into www.stopdiabetes.com.
The ADA is trying to rally 1 Million people to take the diabetes risk test. 26 Million Americans suffer from Diabetes of which 25% are unaware that they have the disease. If the tread continues then over 30% of all Americans will have Diabetes by 2050. Diabetes is the leading cause of blindness and also lower extremity amputations. Please help the ADA meet this goal and long onto the website today.
The Physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are experts in lower extremity diabetic care. If you have any issues with your feet please contact us today at 972-542-2155.
Dr. Eric Silvers and the staff at Advanced Foot and Ankle Center of McKinney and Prosper, Texas are experts in foot and ankle care. Our team is here to help you with you foot and ankle issues.
Hallux Varus
Hallux varus is a deformity that can occur one of two ways. The most common way of developing hallux varus is after having surgery, specifically a bunion surgery in which the deformity was over-corrected. The second way of getting hallux varus is that you were born with it.
Hallux varus occurs when the great toe is deviated medially or in the opposite direction of the 2nd digit. Hallux varus can be a problem especially when wearing shoegear, as the great toe tends to rub against the shoe and create pain, blisters, or ulcerations. If the great toe joint is very unstable, the great toe may dislocate and cause severe pain.
Conservative treatment includes using taping or strapping to hold the hallux in a stable position as it heals. Padding can be added to the inside of the shoe to prevent rubbing and discomfort. The patient must realize that the splinting of the toe in a corrected position, must be in place at all times.
If conservative treatment fails to correct the deformity, surgery can be performed. Depending on the severity of the deformity, the surgery is tailored to what is necessary to correct the deformity. If the deformity is mild, the soft tissue structures such as ligaments, tendons and joint capsule can be repaired. If the deformity s quite severe, then bone work must be performed. Bone work can consist of performing a reverse bunion procedure, using joint implants, and even joint fusion.
The deformity can be mild, moderate or severe. The treatment is geared toward doing the least invasive amount as possible to achieve the best results.
If you have hallux varus that is congenital or as a result of a past surgical procedure, please call us for a consultation. Dr. Eric Silvers is well-versed in revisional and reconstructive repair of surgical complications.
Please call 972-542-2155 for an appointment today.
Porokeratosis of the Foot
Some people have growths on the bottom of their feet. They can range from moles to calluses or melanoma to warts. However, one particular skin lesion is often mistakened for some of the previously mentioned problems. Porokeratoses are hard, seed-like calluses. They are typically about the size of a sesame seed. Oftentimes, porokeratoses feel like a splinter in the foot. They usually develop on the bottom of the foot at the ball of the foot or the heel. Some people call them “seed corns”.
Many podiatrists feel that porokeratoses are sweat glands that are plugged up with callus tissue. There are approximately 300,000 sweat glands on the bottom of the feet, so there is a large opportunity for at least one of the sweat glands to become plugged off.
These lesions are not malignant or dangerous, but they should be examined by a professional to determine the correct diagnosis.
Some patients have several porokeratoses and others may have only 1 or 2. These lesions can become more painful when the person wears shoes with little or no padding or walk around barefoot. Also if the patient has very little fat pad on the bottom of the foot, they may experience increased pain.
At Advanced Foot & Ankle Center, the doctors will attempt to gently carve out the porokeratoma with a currette or a sharp instrument. Anesthesia is usually not needed.
Sometimes, the doctors will place a mild blistering agent on the lesion to cause exfoliation of the lesion and allow it to “pop out”.
If you have a porokeratoma, please come see Dr. Eric Silvers at Advanced Foot & Ankle Center in either McKinney, TX or Prosper, TX. Our office has years of experience with treating porokeratomas.
Please call 972-542-2155 for an appointment today.
Hallux Malleus
Hallux malleus is a deformity of the great toe. This deformity can be very stiff or flexible. The joint in the great toe becomes contracted in a flexed or downward position. This deformity usually occurs due to an imbalance of the tendons that insert on the top and the bottom of the great toe. When the tendon on the bottom of the toe (the tendon that causes the toe to flex down) over powers the tendon that causes the toe to bend up, this deformity occurs.
Oftentimes, patients will develop a callus and even an ulcer on the tip of the great toe. This deformity is often seen in conjunction with hammertoes. High arched feet are typically the most affected by this deformity.
At Advanced Foot & Ankle Center, this deformity is treated initially with padding techniques to prevent sores from developing at the tip of the toe. Custom, soft, accommodative orthoses are sometimes prescribed for the patient to provide cushioning and also to prevent worsening of the deformity.
If conservative treatment fails, surgery is indicated. Surgery usually consists of performing a bone fusion of the two bones in the great toe. This can be done with screws, staples, or wire fixation.
If you have a hallux malleus deformity, please come see Dr. Eric Silvers at Advanced Foot and Ankle Center in McKinney, TX and Prosper, TX.
Call today to schedule an appointment with our team - 972-542-2155.
Psoriasis
Psoriasis is an systemic inflammatory disease that is caused by abnormalities in the immune system. In our practice, psoriasis commonly affects the bottom of the patient’s feet and manifests as a reddened-type rash with silvery scales or flakes of skin. The skin lesions are usually symmetrical. Psoriasis is commonly painful, itchy, inflamed, and can crack or fissure.
Psoriasis can also cause metabolic syndrome which causes patients to be more susceptible to diabetes, high blood pressure, high cholesterol and obesity. Psoriasis patients are more prone to having heart attacks and depression as well.
Psoriasis is commonly misdiagnosed as chronic athlete’s foot. Patient are commonly prescribed antifungal creams medications that do not end up working.
Psoriasis affects the toenails. The toenails will sometimes have little pits or divots. Sometimes the nails with be rough like sandpaper instead of smooth. The nails can have a tendency to come off. The nails can also have a dirty, brown appearance as if the nail was dipped in crude oil. The nails are often misdiagnosed as having fungus.
The patient will often have psoriasis in other places such as the knees, elbows, scalp and along creases in the skin folds such on the bottom or under the breasts. Oftentimes, the hands will manifest identically to the feet.
To diagnose psoriasis, a punch biopsy of the skin is most definitive. Once diagnosed, treatment can be started.
Treatments
Topicals
1. Topical corticosteroids – some topical steroids are very strong and some are not. Some stronger topical steroids are betamethasone, halobetasol, and clobetasol. These meds are typically only used for 1-2 weeks at the most. If they are used for a prolonged time period, it may cause the skin to become thin, develop stretch marks, and cause the skin healing to slow down. The lower dose topical steroids can be used for longer time frames.
2. Vitamin D Analogs – these medicines decrease inflammation and lessen the prominence of the skin lesions. Medications such as Dovonex and calcitriol are used twice daily. Taclonex is a combination of steroid with a vitamin D analog.
3. Topical calcineurin inhibitors – an ointment called Tacrolimus is usually combined with salicylic acid. This ointment locally affects the immune system to slow down the progression of the psoriatic lesions.
4. Keratolytics – skin creams with lactic acid, salicylic acid and urea are often used to decrease the amount of scaling and soften the hard skin.
5. Moisturizers – there is a large quantity of OTC and prescription moisturizers that can be used immediately after bathing to prevent recurrence of skin lesions and keep them at bay.
6. Topical retinoids – a medication called Tazarotene can be used once daily to decrease inflammation and decrease the amount of skin cell development at the site of the psoriatic lesions.
7. Coal tar – can decrease inflammation and itching. The downside to this product is that it has an odor, can stain the clothes and can cause sensitivity to sunshine.
8. Anthralin – research does not yet know how this product works
If you have psoriasis and desire treatment, please come see Dr. Silvers at Advanced Foot & Ankle Center in both McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
Pain in the Ball of the Foot
Almost every person at some point has had pain in the ball of their foot. Most patients don’t know that there is wide array of potential elements that can be factored as the cause of the pain. I am going to discuss a few of the possible cause of metatarsalgia. Metatarsalgia is a trashcan term. It encompasses all the problems that could potentially be cause the ball of your foot to hurt. Below is short list of common problems that can be classified under the term metatarsalgia and how we as doctors come to the conclusion of what you may have.
Examination
I first ask myself these questions.
1. What is the height of the patient’s arch – high or low?
If there is a high arch, the patient usually bears weight on the heel and the lateral ball of the foot, just behind the pinky toe.
If the arch is low, the patient usually bears weight on the medial ball of the foot, or the ball of the foot just behind the big toe.
2. Is there a bunion or hammertoes present?
If the patient has a bunion or hammertoes, patients will bear moreweight on the center ball of the foot.
3. Does the patient have a really long 2nd toe?
If the patient has a long 2nd toe, the patient will bear more weight to the ball of the foot just behind the 2nd toe.
The next thing I do is “push up” test. I apply a load with my hand to the ball of the foot and examine whether the toes straighten out or they remained curved or deviated or contracted. If this is the case, then there may be disruption at the joint capsule at the base of the toe.
I thoroghally examine the range-of-motion of each toe.
I then proceed to examine the spaces between the bones in the ball of the foot. These spaces contain the vessels, nerves and small muscles of the ball of the foot. I press from the top and botom in the spaces while at the same squeezing the sides of the foot together. Sometimes a nerve can be entrapped or squeezed abnormally between the bones and cause pain. Sometimes there can be a fluid filled sac called a bursa in the spaces and cause pain as well.
Next I press on the bones in the ball of the foot. If there is pain at the bases of the toe, just distal to the bones in the ball of the foot, the patient may have a inflammation of the joint capsule. Another test to examine the joints in the ball of the foot is called a Lachman test. The ball of the foot is held in place and the toe is pulled as a unit. This causes stretching of the joint capsule. If this test causes pain, it only reinforces that a joint capsule problem may be occurring.
X-rays are always taken to rule out bone deformities, stress fracture and to make sure the bones in the ball of the foot are normal lengths.
Diagnoses
Once the previous exams are performed, then I attempt to arrive at a diagnosis. The most causes of pain in the ball of the foot in order of most common to least common as seen in the practice are as follows :
1. Metatarsophalangeal joint capsulitis
2. Intermetatarsal space neuroma
3. Metatarsal stress fracture
4. Abnormal metatarsal length
5. Arthritis
6. Avascular necrosis of the metatarsal head
7. Tumors
I know these terms don’t mean much to patients, but feel free to look them up on the internet.
If you have pain in the ball of your foot, please come see Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
