Acute trauma often is the result of dropping an object onto the toe or stubbing the toe against something that forces the nail plate to become separated from the nail bed.  Blunt trauma can cause subungual hematoma’s which is a collection of blood from under the nail plate.  This can cause pain and also can lead to infection.  If a subungual hematoma develops, the collection of blood will need to be drained by either creating a hole in the nail plate or by removing the toenail.  If it is not drained, the pressure will continue to build up and cause pain to the toe.  This can be done by using a needle, cautery or a laser.   Even though the hematoma is evacuated, lysis or separation of the nail plate from the nail bed can still occur and the nail plate may come off prior or during the re-growth of a new nail plate.

Blunt trauma can also lead to laceration of the nail bed that would warrant repair but suture.  In addition, blunt trauma can cause a fracture to the underlying bone (distal phalanx) that would also require treatment.  If the nail bed is traumatized along with a fracture to the distal phalanx, it is classified as an open fracture.

Open fractures have a high risk for infection.  If the bone becomes infected, IV antibiotics and/or removal of infected bone may be necessary.  This could lead to loss of a toe in extreme cases.

Dr. Eric Silvers is a highly-trained foot and ankle surgeon specializing in the treatment and resolution of toenail pathologies.

He has offices located at both McKinney, TX & Prosper, TX.

Please call 972-542-2155 to schedule an appointment today!

The bone spur is caused by traction or pulling on the heel bone or calcaneus by tiny muscles on the bottom of the foot. Many people correlate “heel spurs” with plantar fasciitis. This is a false statement. The plantar fascia in actuality, inserts just lateral to the plantar heel spur. It is the small musculature that causes formation of the bone spur. The reason why the muscles do this is secondary to abnormal and uncontrolled foot mechanics.

Most patients have 1 – 1.5 inches of fat pad on the bottom of the heel that aids in cushioning and shock absorption for the calcaneus. In older patients who have experienced atrophy or thinning of the fat pad, the bone spur can be prominent and very painful.

Treatment includes cushioning of the infracalcaneal exostosis, wearing appropriate shoe gear to soften the impact of the heel with walking or running. Although not available in our office, some plastic surgeons and aestheticians are offering collagen injection therapy to the plantar aspect of the heel to aid in cushioning. It must be known that this is only a temporary solution and often requires multiple periodic injections.

For those patient who cannot find relief cushioning, padding or shoe therapy, surgery is a viable option. Surgery involves removing the plantar heel spur or infracalcaneal exostosis and making the bottom surface of the heel bone flat and smooth. A extended period of non-weightbearing is suggested due to possible risk of stress fracture with early walking following the surgery.

If you have a prominent heel spur on the bottom of the heel, please visit our office for a clinical evaluation. Call 972-542-2155 for an appointment today.

Traumatic Heel Pain

Neurologic Heel Pain

Mechanical Heel Pain

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 treat 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 2 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. Kory Williams or Dr. Eric Silvers at Advanced Foot and Ankle Center in McKinney, TX and Prosper, TX.

Call today to set up an appointment with the podiatrists – 972-542-2155.

Blisters on the feet are very common in athletes. Blisters are not only pain themselves, but they can alter an athlete’s running style and lead to more serious injuries and other foot or ankle problems.

Blisters are caused by friction. The superficial layer of skin, called the epidermis, can separate from from the remaining superficial skin. Internal water pressure causes the a build-up of fluid in the space developed. The higher the force of friction and the amount of time the friction is present, will determine how severe a blister will be. Blisters form more frequently on moist skin. However, very dry skin or very wet skin will lower the frictional forces and prevent blister formation.

To prevent blister formation, you must eliminate or reduce friction. Beginning with shoes, they must fit perfectly. It is thought there should be one finger breadth between the longest toe and the end of the shoe. Shoes that are too skinny will cause blisters on the big toe and the pinky toe. A shoe that has a shallow toebox will cause blister on the top of the toes. Shoes that are too loose tend to cause blisters on the toe tips.

Remember to break shoes in gradually. Do not go out and try to run a marathon in a new pair shoes. Wear your shoes for a few days around the house to get used to them.

So, let us say that the shoes fit great. If the insoles of the shoes don’t fit well, or if they are worn or flattened, abnormal friction may occur. Watch for seams or rough regions inside the shoes.

Socks can also prevent foot blisters. It has been shown that synthetic blends or polypropylene blends can wick away sweat and moisture much better than cotton or wool, thus decreasing the chance for blisters. Also, two layers of socks are better than one in preventing foot blisters. Double up your socks for double cushioning. If the socks have a big toe seam, wearing the socks inside out will prevent the seam from rubbing the toes and getting blisters. Those who exercise excessively and have a lot of foot moisture should always carry an extra pair of socks just in case.

Some athletes will put petroleum jelly, dry soap flakes, or bag balm on the feet to reduce friction from moisture. Daily applications of lanolin at night prior to a big running event will also prevent blisters.

Drying agents such OTC products like Zeasorb and spray deodorant can help as well as prescription antiperspirant, Drysol, also helps prevent moisture.

Sometimes the skin needs to thicken up. By gradually increasing activity each day, the skin will be more apt to not developing blisters as rapidly.

When it comes to pads, pharmacies have a number of items to cushion and protect bony prominences and prevent blister formation. There are felt pads, mole skin, OTC silicone pads, and liquid bandages such as New Skin.

If you do develop a blister, the key is to leave the roof of the blister intact. This prevents infections and subsequent problems. If a large blister needs to be drained, puncture the side of the blister with a sterile instrument, apply antibiotic ointment and cover with a compressive bandage.

If the blister roof comes off, cleanse with blister base with antibacterial soap and water and cover with antibiotic ointment and a bandage.

If you are prone to blisters or have a blister that has become infected, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.

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

]]> http://www.advancedfoottexas.com/2010/12/current-treatments-for-warts-on-the-feet/feed/ 1 http://www.advancedfoottexas.com/2010/10/ucbl-shoe-insert/ http://www.advancedfoottexas.com/2010/10/ucbl-shoe-insert/#comments Mon, 11 Oct 2010 13:59:21 +0000 The Doctors at Advanced Foot & Ankle Center http://www.advancedfoottexas.com/?p=1587

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.

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