Some causes of posterior heel pain can be trauma that results in a fracture or a boney bruise with or without inflammation to the Achilles tendon (tendonitis).  The pain can also be due to mechanical problems such as a tight heel cord (Achilles tendon).  In addition, bone spurs that result from long term pulling (traction) of the Achilles tendon can develop and produce a bump or prominence along the back of the heel.   Some types of arthritis can also cause spurs to the heel. 

Many times bone spurs along the back of the heel are not painful.  When they do become painful, the experts at Advanced Foot and Ankle Center in McKinney and Prosper, Texas can help you find relief.  Our treatment plans for posterior heel pain are conservative yet aggressive.  Dr. Silvers will evaluate your heel pain both clinically and radiographically (x-rays, CT and/or MRI if needed).  He may choose to have some blood work taken after conducting a history and physical examination.  Some conservative treatment options include heel lifts, walking boots, casting, oral steroids, oral or topical anti inflammatories, shoe modifications, physical therapy, and altering activity. 

If a course of aggressive conservative treatment fails after 3-9 months, then surgical options for patients who are surgical candidates may be explored.  Such surgical treatments involve addressing the heel spur and the Achilles tendon.  If Dr. Silvers finds that the Achilles tendon is short or tight, he will suggest lengthening in addition to removing the heel spur.   Dr. Silvers uses the most advanced techniques for treating heel spurs along the back of the heel.  Today, Dr. Silvers utilized the Arthrex Speed Bridge System.   “I like the Speed Bridge because it provides a stable and strong means of reattaching the Achilles tendon to the heel after bone spur resection.  In the 14 years since I have been performing poserior heel spur surgery, I have yet to find an anchoring system that matches up to the Arthrex Speed Bridge.  The speed bridge is nice not only that if utilizes 4-3.5 mm bioabsorbable anchors, but it is also a knotless system.  That means that we no longer have to bury knots within the tendon as it is reattached to the heel bone.  In addition, the criss crossing of the sutures attached to the anchors provides a wide surface area of compression to the Achilles tendon and the heel bone.”

Despite the great advancements to reattaching the Achilles tendon to the heel bone, recovery does take a minimum of 6 weeks of non weight bearing on the involved foot.  After the six week period, another 2-6 weeks of utilizing a walking boot is required. 

If you suffer from posterior heel pain (pain along the back of the heel) call Advanced Foot and Ankle Center to schedule an appointment to see Dr. Eric Silvers.  Dr. Silvers has patients that have come to Texas from all over the country to see him including, Florida, California, Arkansas, Oklahoma, Michigan, Illinois, just to name a few. 

You can reach us by calling 972-542-2155.  Our friendly staff is sympathetic to your heel pain needs and will do their best to get you into our office for a personalized consultation with Dr. Silvers directly.

The first area in which bursae can develop is on the bottom of the heel. This bursa is called an adventitial bursa. It is usually located between the calcaneus and the fat tissue. It can become prominent and can sometimes be felt or palpated. It may fell as thought the patient is waling on a pillow or fluid filled sac. It creates pain due to the vast amount inflammatory cells located within in the sac and from increased pressure from swelling. It may occur in conjunction with plantar fasciitis or with an infracalcaneal exostosis.

The second and third types of bursae that can form on the heel are located on the back or posterior aspect of the heel. Although they are both on the back of the heel the location is slightly different for each. The first bursa is called a retrocalcaneal bursa and the second is called a pre-achilles bursa. Basically, one bursa is located in front of the achilles tendon and the other is located behind or posterior to the achilles tendon just under the surface of the skin.

The retrocalcaneal bursa is located behind or posterior to the achilles tendon just under the skin. This bursa usually form due to increased pressure from a retrocalcaneal exostosis or heel spur on the back of the heel bone.

The pre-achilles bursa is located in front of the achilles tendon. This bursa is essentially sandwiched between the achilles tendon and the heel bone. This bursa usually forms in conjunction or simultaneously with a Haglund’s deformity.

Bursae are typically treated initially with NSAIDS or topical anti-inflamatory gels or creams. Immobilization is typically incorporated in the treatment regimen. Injection therapy with corticosteroids may be implemented if the injections can be administered under the guidance of ultrasound or live x-ray.

If the previous mentioned conservative therapies fail and no relief is achieved, then surgical removal of the bursa is performed.

If you feel you may have a inflamed bursa on the heel, please call 972-542-2155 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.

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 opposite direction of the 2nd digit. Hallux varus can be  a problems 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.

Literature provides many options and methods on fixing hallux varus and my intentions are to inform you (in basic terms) how it can be fixed.

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.

Please be aware that this 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 from an old botched bunion procedure, please come see us. Dr. Kory Williams and Dr. E. Silvers are well-versed in revisional and reconstructive repair of failed surgeries.

Please call 972-542-2155 for an appointment today.

When people have plantar fasciitis or pain on the bottom of the heel or arch, they may feel a stabbing or sharp pain. Many people think they have a large heel spur tring to poke out the bottom of their heel.

In actuality, not all people who have plantar fasciitis have a heel spur. You must not correlate the size of a heel spur with the amount of heel pain present. Many patients walk into our office everyday with plantar fasciitis and have no remnants of a heel spur. Many patients walk into the office with a huge heel spur and have absolutely no heel pain. But there are people who fall in the middle and have plantar fasciitis and do have a heel spur.

Some think that the heel spur develops because of traction or pulling on the bone by the plantar fascia.  This is completely false. In the foot, there are dozens of small tiny muscles, especially on the bottom of the foot. Research has shown that if a patient has a heel spur and dissection was performed on the patient’s foot at the site of the heel spur, it would show that the plantar fascia does not insert on the heel spur. Instead, about 2-3 tiny muscles in the bottom of the foot originate from heel spur. The plantar fascia actually inserts on the bottom of the heel bone just lateral or below the heel spur. Poor foot mechanics can cause greater muscle activity inside the foot and lead to the development of the heel spur.

What are the 2 most common things that can happen if the heel spur is taken out?

1. Possible stress fracture of the heel bone

2. Deep space infection in the surgical area

Overall, heel spur removal is seldom necessary in treating pain associated with plantar fasciitis. There is no correlation of the heel spur with the plantar fascia from an anatomic perspective. Many people get better from plantar fasciitis with conservative therapy while the heel spur remains present. According to the latest research, there is no evidence to support routine surgical removal heel spurs during the course of a plantar fascia surgery.

If you have plantar fasciitis and you are interested in having surgery on the foot, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.

Call 972-542-2155 for an appointment today.

Rheumatoid arthritis is a disease with inflammatory changes through out the connective tissues. It is generally a wasting disease with muscle and bone atrophy. Chronic inflammation causes damage to joint capsules and cartilage which are replaced with inflammatory tissue.

On x-ray, the cartilage is worn away, leaving no joint space and bone-on-bone grinding. The bone density lessens at the joint and the bone shows areas which have been “chewed up” from the inflammatory changes. Most joints end up becoming dislocated and have severity deformity.

Rheumatoid arthritis mostly affects the small joints of the foot. Therefore, most of the deformity lies at the toe or forefoot level. It can also be present in the hindfoot or ankle causing collapsing of the foot or ankle and causing a severe flatfoot deformity.

Clinically, most patients have severe pain after periods of immobility. Joints become very stiff and difficult to manuever. Pain and stiffness often subside somewhat after motion has proceeded and the joint “warms up.” Prolonged activity therefore thereafter can lead to worsening of pain.

Symptoms of rheumatoid arthritis can include weight loss, fever, coldness, numbness, tingling, fatigue and malaise. Common findings are symmetrical swelling of the toes, tenderness with touch, and pain with motion. The swelling is often spongy or rubbery. When there is limited motion for a prolonged time period, muscle wasting and joint contracture occurs. This is usually followed by joint fibrosis and fusion of bones. Sometimes, large nodules can form on the ball of the foot or on the toes. These are called rheumatoid nodules.

The diagnoses of rheumatoid arthritis is based on disease characteristics over time. Classic rheumatoid arthritis displays seven of the following symptoms, the first five presenting for at least 6 weeks:

• Morning stiffness
• Painful range of motion in at least one joint
• Swelling in at least one joint
• Swelling of at least one other joint
• Symmetrical joint involvement with simultaneous involvement of the same joint on both sides of the body
• Subcutaneous nodules
• X-ray changes typical of RA
• Positive blood test showinf rhematoid factor
• Joint fluid changes
• Changes in the structure of the joint capsule on microscope

Rheumatoid arthritis is a devastating disease causing severe changes in the feet. If you have RA, several things can be done to alleviate your pain.

Custom orthotics and braces

Orthotics can be custom molded to the feet to accommodate nodules and bony prominences. We offer accommodative orthotics that are very cushioning and can provide excellent comfort. Custom braces can e molded to your extremity to alleviate the most severe deformities.

Surgery

Oftentimes, surgery is very successful in alleviating rheumatoid foot pain. Excision of rheumatoid nodules, or straightening of digits or bunion deformities can be performed.

Please come to Advanced Foot & Ankle Center and see Dr. Williams or Dr. Silvers if you have RA and we will provide the utmost and highest quality care for your feet.

Tarsal Coalition

The term tarsal coalition may sound like a natural disaster or such, but the staff and physicians at Advanced Foot and Ankle Center assure you that it is not.

The word “tarsal” refers to the group of bones located in the foot just in front and below the ankle.  The bones that compromise the tarsus are the talus, calcaneus, navicular, cuboid and the three cuneiform bones.  The word “coalition” refers to a failure of a joint or joints to form.  Thus, a tarsal coalition is a failure of a joint or joints to form between the bones in the rearfoot.  One or more joints can have coalitions.  Developmentally speaking, a coalition is a failure of mesenchymal differentiation during fetal development.  With that being said, most coalitions are present at birth.  Trauma does not cause coalitions but can cause severe arthritis that can lead to joint fusion by gradual wearing away of cartilage or by a fracture through a joint.

The symptoms of a tarsal coalition typically do not present early in life.  Many times, symptoms are not seen until 9-12 years old or even later.  Some symptoms of a tarsal coalition include a fallen stiff arch, pain with walking and running, foot fatigue, awkward gait or walking pattern, or spasm and muscle cramps of the foot or lower leg.

Diagnosis can be relatively easily by examination by Dr. Silvers and Dr. Williams at Foot and Ankle Center.  During their evaluation, they will place the patients foot through range of motion, to assess the presence or absence of a joint or joints.  In addition, x-rays will be taken in the office to evaluated the bones and joints of the foot.  Since coalitions may be fibrous (soft tissue), cartilage, or bone, advanced Imaging Studies such as MRI or CT may be ordered.

Treatment

Treatment of tarsal coalitions can be broken down into surgical and non surgical treatments.  Non surgical treatment is aimed at reducing inflammation and abnormal motion in the foot.  This can be accomplished with Custom Molded Foot Orthotics, oral non steroidal anti-inflammatory drugs, cortisone injections, physical therapy and cast and/or walking boot immobilization.

Surgical treatment is only performed if conservative treatment fails.  Dr. Silvers and Dr. Williams exhaust all conservative options prior to operating on feet with tarsal coalitions.

For an appointment with Dr. Silvers or Dr. Williams, please call us at 972-542-2155.

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/2010/11/bunion-surgery/ http://www.advancedfoottexas.com/2010/11/bunion-surgery/#comments Mon, 22 Nov 2010 17:11:11 +0000 The Doctors at Advanced Foot & Ankle Center http://www.advancedfoottexas.com/?p=1604

The following video shows exactly how Dr. Williams and Dr. Silvers perform most of their bunion procedures. Please watch!

If you have more questions regarding bunion surgery and the intricacies of the procedures, please call 972-542-2155 to make an appointment with us today!

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