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.
Current Treatments for Warts on the Feet
A plantar wart (verruca plantaris) is a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot and typically resembles a cauliflower.
A plantar wart may have small black specks within it that bleed when the surface is cut or shaved; these are abnormal capillaries or blood vessels feeding the wart.
Though the name plantar wart describes specifically HPV infection on the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand, where the appearance of the wart is often exactly as described above for plantar warts. Because of pressure on the sole of the foot, a layer of hard skin forms over the wart.
A plantar wart may or may not be painful. It can be spread in showers, around swimming pools, by sharing shoes, etc. Plantar warts, can often be differentiated from corns by close observation of the skin lines. Feet, like hands, are covered in skin lines or “fingerprints”. With plantar warts, the skin “fingerprints” go around the lesion. If the lesion is not a plantar wart, the fingerprints continue across the top layer of the skin.
Plantar warts tend to be painful on with pressure from either side of the lesion rather than direct pressure. Corns tend to be painful on direct pressure rather than pressure from either side. The difference between plantar warts and warts on other parts of the body is that warts are generally outgrowth lesions, but on the bottom of the foot, they are pushed inward by the pressure of walking.
Since the skin on the bottom of the foot tends to be thicker, the treatment of plantar warts is more difficult.When discussing treatments, no treatment in common use is 100% effective.
Podiatrists are considered specialists in the treatment of plantar warts. Although immunization is available for the HPV and strains causing cervical cancer, there is currently no vaccination treatment for plantar warts.
Treatments:
1. Topical Keratolytics
A. Salicylic Acid
B. Canthiridin (Canthacure)
C. Urea
D. Mono- and Trichloroacetic acid
2. Cryotherapy
A. Histofreeze
B. Verruca-freeze
3. Immunomodulators
A. Imiquimod
B. Interferon – A
C. Interleukin – 12
D. Tumor Necrosis Factor – A
4. Autoimmunization
A. Needling of Warts
B. Remote burying of warts
5. Immunotherapy
A. Mumps-Measles-Rubella vaccine
B. Candida albicans antigen injection
C. Cimetidine (Tagamet)
D. Zinc sulphate
6. Laser Treatment
A. Pulse dye laser
B. Carbon Dioxide laser
7. Chemotherapy
A. Formaldehyde
B. 5 – Flourouracil
8. Excision
9. Occlusion
A. Duct tape
UCBL Shoe Insert
The UCBL shoe insert is a maximum control foot orthotic that was named after the location in which it was developed – University California Berkeley Laboratory in 1967.
The UCBL foot orthosis is used to stabilize a flexible foot deformity, which in most cases is a flexible flatfoot. The UCBL differs from other foot orthoses in that it fully encompasses the heel with a molded heel cup which in turn holds the heel, or hind foot, in a neutral, vertical position. While correcting and holding the heel in a neutral position, the UCBL also controls the inside arch of the foot and the outside border of the forefoot. These 3 corrective forces keep the foot held in a neutral position.
It is very important to understand that the foot must be flexible enough to be held in a neutral position comfortably. If the foot deformity is rigid, the UCBL will be very uncomfortable if used to try and correct the deformity. If the foot is rigid, the UCBL is made to the shape of the foot and the goal is to prevent further deformity.
The UCBL is made out of a rigid material, usually plastic, that is molded over a replica of the foot that is created by casting the foot. The foot section of the insert usually ends behind the toes by the ball of the foot. This allows for a natural rollover motion at the toes when walking.
The UCBL ends just below the ankle bones. Because of this design, the UCBL is not seen outside of the shoe. The best shoes to accommodate the UCBL are basic gym shoes or walking shoes with laces or Velcro. The UCBL does not work well with dress shoes or sandals.
This orthotic is very well suited for children with a flexible flatfoot deformity. If you or your child has a flexible flatfoot, please make an appointment to see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX or Prosper, TX.
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
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
Neuromas
A neuroma is a benign swelling of a nerve that is secondary to trauma or compression. If the swelling of the nerve is chronic, then permanent nerve damage can occur. A very common area for a neuroma to occur is in the ball of the foot.
Neuromas are usually occur due to compression between the metatarsal bones, which are long bones located just behind the toes. Nerves course between the metatarsal bones to provide sensation to the toes. At the base of the digits, the nerve splits into a Y shape and enters the toes. Where the nerve splits into a Y is usually where the nerve gets pinched, causing swelling and ultimately the neuroma. A neuroma can manifest as burning pain, tingling and numbness. It has been shown that by removing the shoe and rubbing the foot, symptoms can be alleviated.
As the nerve continues to swell and become larger, the nerve can create a clicking or poppnig sensation when walking as it moves between the metatarsal bone. The neuroma pain comes and goes and is further aggravated by pinching of the nerve.
The most common region of the foot to develop a neuroma is between the 3rd and 4th toes, but also between the 2nd and 3rd toes. Neuromas can occur in both feet or just one foot.
Neuromas are diagnosed by a thorough history and physical exam. Neuromas can often be mistaken for arthritis, stress fractures, avascular necrosis, capsulitis, etc. X-rays are taken to rule out the previously mentioned problems. X-rays do not show neuromas. Sometimes, special exams such as MRI or nerve conduction studies must be performed to help with the diagnosis.
Treat for neuromas usually consistent of one if not several of the following:
1. Corticosteroid injections
2. Orthotics
3. Chemical destruction of the nerve
4. Surgery
If you think you have a neuroma, please contact Advanced Foot & Ankle Center and schedule an appointment with Dr. Kory Williams or Dr. Eric Silvers.
We are highly trained in the treatment of this problem and we can help you.
Have a nice day!
~Dr. Williams
