A Case of Athlete’s Foot
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
Subungual Exostosis
True subungual exostoses arise from the tuft of the distal phalanx. They are composed of mature bone with a fibrocartilaginous cap. Lee et al (2007) noted that half of their subungual lesions were actually osteochondromas arising from the proximal part of the distal phalanx and covered with hyaline cartilage organised as in a growth plate. True exostoses are commonest in young adults with a female predominance. They mainly occur in the great toe, although they also occur in the lesser toes and fingers.
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
What is Madura Foot?
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.
Crazy Shoes: Are These For Real?
I thought you guys might get a laugh when looking at these absurd shoes.
Enjoy! Have a great day!
P.S. – These are not recommended to wear.
~Dr. Williams
Subungual Hematoma
Have you ever been cooking in the kitchen and dropped a can of vegetables on your toenail ? Have you ever ran for a long time and developed blood under a toenail. I am guessing at some point you have had blood under the nail plate whether due to direct trauma or repetitive microtrauma. The scientific name for blood under the nail plate is subungual hematoma.
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.
Brachymetatarsia
Brachymetatarsia is characterized by an abnormally short metatarsal bone. 
The condition usually runs in certain families. This condition usually affect the 4th metatarsal, but may affect multiple metatarsal bones.
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