Tarsal Coalition
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.
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
Bunion Surgery
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!
Toe Ulcer Caused By a Bone Spur
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
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
