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.

Neurologic Heel Pain

Mechanical Heel Pain

Advanced Foot & Ankle Center is now offering custom molded flip flops. They are called Flopthotics. Custom molded orthotics are great, however, wearing them in tennis shoes all summer can sometimes be a drag. Enjoy the comfort and support of a custom orthotic with style and breatheability of a flipflop.

The casting process involves making a cast of the foot using a foam impression. The foam impression is then sent to Barcelona, Spain to Edser Labs for manufacturing. There is a guaranteed 10 day turn- around time for the flip flops.

Advanced Foot & Ankle Center is now offering a package deal in which a patient can get a pair of regular custom orthotics that fit into normal shoegear (the cost depends on your insurance benefits) and for additional $150.00, the Flopthotics can be casted for as well.  If the regular custom molded orthotics are not purchased or not wanted and you only want the custom molded flipflops, the Flopthotics are $200.00. The Flopthotics are not a covered item through insurance. Take advantage of this wonderful deal  offered. This deal will last for 90 days starting 4/28/2011.

Enjoy the summer in a pair of custom molded flipflops. Visit edserlabs.com for more pictures and additional information regarding the Flopthotics.

Call 972-542-2155 to schedule an appointment today.  Advanced Foot & Ankle Center is located in McKinney, TX and Prosper, TX.

Incidence of Diabetes Mellitus

- 15% of the population of developed nations

- 16 million people in U.S have diabetes mellitus

- 15% of patients with diabetes will develop foot ulcers

- There are currently 2.4 million people with diabetic foot ulcers

- Foot and leg amputations are 15 times more likely in patients with diabetes

- 15% of people with foot ulcers will require amputations

Morbidity and Mortality

- Half of the non-traumatic foot amputations in the United States are the result of diabetes

- The 3 year survival rate after a leg or foot amputation is 50% in diabetic patients

- 50% of diabetic amputees will develop ulcers on the opposite limb

- 50% of those diabetic patients will lose the other limb in 3 years or die

Cost

- Total cost for diabetic care in 1997 = $98,000,000,000.00

- Diabetic foot care in 1997 = $6,000,000,000.00

- Non-operative care of a single foot ulcer = $7,000.00

- Average cost of care for an infected foot ulcer = $17,000.00

- Average cost of amputation and rehab = $45,000.00

Misconceptions

- 68% of patients with diabetic foot ulcers have neuropathy

- 32% of patients with diabetic foot ulcers have normal sensation

How effective are orthotics?

- Re-ulceration rate at one year = 58% if return to street shoes, 28% if return to therapeutic shoes with in soles

If you have diabetes and you have a diabetic foot ulcer, please come see us at Advanced Foot & Ankle Center to be looked at. Even if you do not have have a foot ulceration, but you have diabetes, there are things that can be done by Dr. Kory Williams and Dr. Eric Silvers to prevent future problems. Act now. The future of your foot health depends on it. Call 972-542-2155 to set up an appointment now.

The five basic types of running shoes are as follows:

1. Motion control running shoes

2. Stability running shoes

3. Cushioned running shoes

4. Trail running shoes

5. Racing running shoes

The motion control, stability and cushioned running shoes are fitted according to the runner’s foot type; which is either pronated, overpronated or supinated. The trail and racing shoes are fitted according to the type of race or terrain the runner will be running on.

Motion Control Shoes

These shoes are designed primarily for runners who have low arches, who are moderate to severe over pronators, and runners who are heavier and need extra support.

These shoes are manufactured to prevent a runner’s foot from rolling inward too much (over-pronating). These shoes tend to be more rigid, heavier, have a wider outsole and have a high density sole (medial post) on the medial aspect of the shoe where the arch lies.

The medial post is a wedge of high density EVA material that is inserted into the sole of the shoe on the medial side. The EVA material resists compression which ultimately reduces the amount the foot rolls inward with each running stride.

Stability Shoes

These shoes are best for runners who have medium arches and for those who are mild to moderate pronators.

Stability shoes offer features found in both motion control and cushioning shoes, but to a lesser degree. The primary function of these shoes is to support the foot without interfering the foot’s natural pronation. These shoes have excellent arch support and midsole cushioning. These shoes are not as restrictive as motion control shoes. These shoes have tendency to e curved inward slightly. This shoe is the best for most runners.

Cushioned  Shoes

These shoes are best for runners who have high arches and for those runners who are supinators or under-pronators.

These shoes are designed to provide shock absorption and extra cushioning for people with high arches. These shoes are slightly curved in order to encourage pronation. These shoes are more flexible, have softer midsoles, and less medal support.

Trail Shoes

These shoes are best for off-road running, extra traction, durability, and for runners who need thicker more durable soles of the shoe.

These shoes are tough enough to withstand bad weather and rough terrain.

Racing Shoes

These shoes are best for runners who have no motion control problems and for those runners who need shoes for fast paced training or racing.

These shoes offer very little in terms of stability, cushioning or durability features. They are very lightweight. These shoes have a low heel and flexible forefoot. They are not recommended for runners with injures or pronating problems.

This information was excerpted from the Shoe Wearer’s Handbook by Clare Barron and Kent Basson, pages 46-49.

A patient presented to my office complaining of painful “sore” on the right great toe.  The patient stated the he had this painful sore in the past and was healed successfully with local wound care.  Upon examination of the x-rays taken in my office, it was noticed that the patient had a large bony spur at the direct spot where the ulcer was present.

Therefore, the ulcer was due to a large bony spur. The skin could no longer withstand the pressure between the bone spur and the ground and started breaking down and ultimately developed an ulcer.

This patient was advised that the most definitive treatment would include removal of the bone spur that is causing the ulceration. Patient is currently undergoing local wound care treatment.  Updates will be provided in the future.

~Dr. Williams

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

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

]]> http://www.advancedfoottexas.com/2010/03/a-case-of-athletes-foot/feed/ 0 http://www.advancedfoottexas.com/2010/02/subungual-exostosis/ http://www.advancedfoottexas.com/2010/02/subungual-exostosis/#comments Mon, 22 Feb 2010 15:04:25 +0000 The Doctors at Advanced Foot & Ankle Center http://www.advancedfoottexas.com/?p=1114 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