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

Mechanical Heel Pain

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.

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.

Psoriasis is an systemic inflammatory disease that is caused by abnormalities in the immune system. In our practice, psoriasis commonly affects the patient’s bottom of the feet and manifests as a reddened-type rash with silvery scales or flakes of skin. The skin lesions are usually symmetrical. Psoriasis is commonly painful, itchy, inflamed, and can crack or fissure.

Psoriasis can also cause metabolic syndrome which causes patients to be more susceptible to diabetes, high blood pressure, high cholesterol and obesity. Psoriasis patients are more prone to having heart attacks and depression as well.

Psoriasis is commonly misdiagnosed as chronic athlete’s foot. Patient are commonly prescribed antifungal creams medications that do not end up working.

Psoriasis affects the toenails. The toenails will sometimes have little pits or divots. Sometimes the nails with be rough like sandpaper instead of smooth. The nails can have a tendency to come off. The nails can also have a dirty, brown appearance as if the nail was dipped in crude oil. The nails are often misdiagnosed as having fungus.

The patient wil often have psoriasis in other places such as the knees, elbows, scalp and along creases in the skin folds such on the bottom or under the breasts. Oftentimes, the hands will manifest identically to the feet.

To diagnose psoriasis, a punch biopsy of the skin is most definitive. Once diagnosed, treatment can be started.

Treatments

Topicals

1. Topical corticosteroids – some topical steroids are very strong and some are not. Some stronger topical steroids are betamethasone, halobetasol, and clobetasol. These meds are typically only used for 1-2 weeks at the most. If they are used for a prolonged time period, it may cause the skin to become thin, develop stretch marks, and cause the skin healing to slow down. The lower dose topical steroids can be used for longer time frames.

2. Vitamin D Analogs – these medicines decrease inflammation and lessen the prominence of the skin lesions. Medications such as Dovonex and calcitriol are used twice daily. Taclonex is a combination of steroid with a vitamin D analog.

3. Topical calcineurin inhibitors – an ointment called Tacrolimus is usually combined with salicylic acid. This ointment locally affects the immune system to slow down the progression of the psoriatic lesions.

4. Keratolytics – skin creams with lactic acid, salicylic acid and urea are often used to decrease the amount of scaling and soften the hard skin.

5. Moisturizers – there is a large quantity of OTC and prescription moisturizers that can be used immediately after bathing to prevent recurrence of skin lesions and keep them at bay.

6. Topical retinoids – a medication called Tazarotene can be used once daily  to decrease inflammation and decrease the amount of skin cell development at the site of the psoriatic lesions.

7. Coal tar – can decrease inflammation and itching. The downside to this product is that it stinks, can stain the clothes and can cause sensitivity to sunshine.

8. Anthralin – research does not yet know how this product works

When a patient presents to my office for an initial visit and presents with psoriasis, I will use a combination of a few of the medications mentioned above.

If you have psoriasis and desire treatment, please come see Dr. Kory Williams and Dr. Silvers at Advanced Foot & Ankle Center in both McKInney, TX and Prosper, TX.

Call 972-542-2155 for an appointment today.

Almost every person at some point has had pain in the ball of their foot. Most patients don’t know that there is wide array of potential elements that can be factored as the cause of the pain. I am going to discuss a few of the possible cause of metatarsalgia. Metatarsalgia is a trashcan term. It encompasses all the problems that could potentially be cause the ball of your foot to hurt. Below is short list of common problems that can be classified under the term metatarsalgia and how we as doctors come to the conclusion of what you may have.

Examination

I first ask myself these questions.

1. What is the height of the patient’s arch – high or low?

If there is a high arch, the patient usually bears weight on the heel and the lateral ball of the foot, just behind the pinky toe.

If the arch is low, the patient usually bears weight on the medial ball of the foot, or the ball of the foot just behind the big toe.

2. Is there a bunion or hammertoes present?

If the patient has a bunion or hammertoes, patients will bear moreweight on the center ball of the foot.

3. Does the patient have a really long 2nd toe?

If the patient has a long 2nd toe, the patient will bear more weight to the ball of the foot just behind the 2nd toe.

The next thing I do is “push up” test. I apply a load with my hand to the ball of the foot and examine whether the toes straighten out or they remained curved or deviated or contracted. If this is the case, then there may be disruption at the joint capsule at the base of the toe.

I thoroghally examine the range-of-motion of each toe.

I then proceed to examine the spaces between the bones in the ball of the foot. These spaces contain the vessels, nerves and small muscles of the ball of the foot. I press from the top and botom in the spaces while at the same squeezing the sides of the foot together. Sometimes a nerve can be entrapped or squeezed abnormally between the bones and cause pain. Sometimes there can be a fluid filled sac called a bursa in the spaces and cause pain as well.

Next I press on the bones in the ball of the foot. If there is pain at the bases of the toe, just distal to the bones in the ball of the foot, the patient may have a inflammation of the joint capsule. Another test to examine the joints in the ball of the foot is called a Lachman test. The ball of the foot is held in place and the toe is pulled as a unit. This causes stretching of the joint capsule. If this test causes pain, it only reinforces that a joint capsule problem may be occurring.

X-rays are always taken to rule out bone deformities, stress fracture and to make sure the bones in the ball of the foot are normal lengths.

Diagnoses

Once the previous exams are performed, then I attempt to arrive at a diagnosis. The most causes of pain in the ball of the foot in order of most common to least common as seen in the practice are as follows :

1. Metatarsophalangeal joint capsulitis

2. Intermetatarsal space neuroma

3. Metatarsal stress fracture

4. Abnormal metatarsal length

5. Arthritis

6. Avascular necrosis of the metatarsal head

7. Tumors

I know these terms don’t mean much to patients, but feel free to look them up on the internet.

If you have pain in the ball of your foot, please come see Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.

Call 972-542-2155 for an appointment today.

Puncture wounds can hurt. They can vary from safety pins to needles and from toothpicks to knife wounds. The question is “How do we treat them at our office?” First, puncture wounds can be very difficult or very easy to fix.

An intensive history and precise account of the method in which the puncture wound occurred is taken from the patient.

X-rays are usually taken to rule out that a foreign body is still present inside the foot.  Ultrasound can also be used to examine the foot for retained foreign body.

If it has been several days since the puncture wound occurred, an MRI may be warranted to rule out bone infection or an abscess inside the foot. Sometimes, a nuclear bone scan can also be used to rule out out or rule in bone infection.

X-rays can also rule out gas gangrene in the tissues.

Sometimes blood labs are taken to analyze the white blood cell count (high in infection and inflammation), electrolytes, and a few other markers called ESR and CRP (also high in inflammation and infection).

After this, the puncture site is often cleaned and prepped for foreign body retrieval. All abscesses or pus pockets are drained properly. All bad tissue is removed. If the foreign body is able to be sen, then it is removed. If the foreign body is very deep and unable to be retrieved in the office, then usually surgical intervention is taken and the patient is taken to the operating room  for use of live x-ray for more a more intensive search for the object.

If MRI has shown that bone infection is present, then all necrotic or infected bone is removed fully.

Once the foreign body is take out, the wound is flushed with sterile saline.

Sometimes, the wounds must be left open to drain, especially if they are infected. If the wound is large, sometimes the patients have to be taken back to the operating room for closure of the wound after all infection has been drained out.

Patient are usually placed on antibiotics, either for prophylaxis or to treat a fully developed infection.

If you have a puncture wound, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center for treatment.

Call 972-542-2155 for a 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.

It is thought that ankle sprains happen about 30,000 times per day and make up about 30% of all sports injuries. An estimated 60% of people who suffer from an ankle sprain never seek professional or podiatric treatment. Half of those people will develop chronic symptoms such as severe ankle pain, swelling, recurrent injury, and instability of the ankle.

Research has shown that low grade ankle sprains develop chronic symptoms just as frequently as high grade ankle sprains. This evidence shows that even mild sprains deserve professional attention.

There is huge debate on how ankle sprains should be treated. There are physicians who believe immobilization is the answer. There are others who feel immobilization is wrong. There are also other doctors who think surgery is the most appropriate answer to repairing severe sprains.

When comparing immobilization to mobilization or “functional treatment”, functional treatment has been shown as the best treatment. This proves true when looking return to work, return to sports, pain swelling, range of motion, and cost.

Early mobilization also reduces the degenerative effects of immobilization. Research has shown there is no benefit to immobilizing lateral ankle sprains and may doctors feel that immobilization should be abandoned except in select patients.

Is surgery the best option? Not always. Journals reveal that early mobilization still provides the fastest recovery of ankle joint mobility with the quickest return to sport. Surgery is only indicated when the individual continues to suffer from recurrent sprains and instability.

How do we treat lateral ankle sprains at Advanced Foot & Ankle Center?

First, if the sprain is fresh and there is a moderate to severe amount of swelling present, the patient is placed into a compression dressing such as an UNNA boot. An UNNA boot is tight compressive dressing comprised cast padding and calamine impregnated guaze. See the picture below:

If the swelling is minimal and no compression is needed, then depending on the severity of the sprain then one of two things is performed:

1. Support with an ASO Ankle Brace

2.  Immobilization in a pneumatic walking boot

Once a short period of immobilization is performed, physical therapy may be implemented to increased range-of-motion, ankle strength, walking or running capabilities and balance.

If the patient continues to have severe pain regardless of immobilization or early mobilization via physical therapy, then an MRI may be warranted to examine the integrity of the ankle ligaments.

If the MRI is performed, and there is evidence of ankle ligament rupture, then surgical intervention may be implemented. Surgery repair of ankle ligaments will be explained in more details by the doctors in the office if warranted.

If you have suffered from chronic ankle instability or have suffered a recent sprain, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center for assessment and treatment.

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