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

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 retrocalcaneal exostosis is a painful bump or bone spur on the back of the heel. This painful bone spur involves the achilles tendon. A Haglund’s deformity is a painful bone spur on the back of the heel that does not involve the achilles tendon.

Patients will often complain of pain, redness, tenderness and swelling along a bony prominence on the posterior aspect of the heel. Usually the pain is worse with activity and shoes that rub the back of the heel.

Usually the patient has pain at the distal insertion site of the achilles tendon. Sometimes the achilles tendon will feel thick, hardened, or rubbery where it inserts on the posterior aspect of the heel. This may be due to the tendon becoming calcified or possible tear of the tendon.

This particular problem most often affects adults. Women are typically more affected than men because of the types of shoes they wear. HIgh heeled shoes or pumps irritate the spurs the most.

A retrocalcaneal exostosis can occur with other problems of the back of the heel. Other problems that can happen are: tight or short achilles tendon, bursitis or an inflamed pad, achilles tendonitis or inflammation  and Haglund’s deformity.

If a patient has equinus or a tight or short achilles tendon, this lack of flexibility of the achilles tendon puts increased tension on the back of the heel.

A bursa is an inflamed sac of fluid that develops as a way of your own body cushioning the back of the heel.  There are 2 types of bursae that can form. One is very superficial and is in between the skin and the achilles tendon. The other type of bursa is sandwiched between the achilles tendon and the heel bone or calcaneus. When they become inflamed, it can become very tender with even the lightest pressure.

If the achilles tendon itself is inflamed and swollen, it may be due to a tear or partial  rupture of the achilles tendon.

So, how do we treat retrocalcaneal exostoses at Advanced Foot & Ankle Center. First it depends on the severity of your pain level. The first thing that is usually done includes the following:

1. A prescription for an oral NSAID or steroid which is up to the doctor’s preference. This will help wit inflammation of the tendon, bursa, skin other structures in the area.

2. Prescription for a pain gel or adhesive pain patch to apply to the back of the heel. These medications are diffused through the skin into the tissues.

3. Heel lifts are usually dispensed to the patient. Heel lifts are like a wedge that goes under the heel and lifts up the heel. This device does 2 things. First, by raising up the heel an inch or so, its puts some slack into the achilles tendon and decrease the tension or pull on the back of the heel. The second thing it does is it can raise the patient’s heel out of the shoe slightly to keep the back of the shoe from rubbing on the back of the heel.

4. Cushioning or padding of the back of the shoe or the heel counter. Using adhesive felt pads, which are available both in our office and can be purchased at stores like Hobby Lobby or Micheal’s, can be used to stick on the inside of the heel of the shoe to provide some cushioning.

5. If the pain is really bad, immobilization in a boot is warranted. The boot is called a pneumatic CAM walker and the purpose of this device is to keep you from using the achilles tendon. By decreasing stress and strain of the achilles tendon, the pain and inflammation at the back of the heel will decrease significantly.

6. If the pain is quite severe, the last conservative option is to be casted in a big, soft fiberglass cast. Crutches would be warranted for non-weightbearing of the foot.

7. Steroid injections are not customarily performed at the back of the heel due to increased risk of possible rupture of the achilles tendon, especially if the tendon is already inflamed and diseased.

8. Sometimes physical therapy is warranted to help increase flexibility of the achilles tendon and to decrease inflammation of the tendon using techniques customized by the physical therapists.

9. MRI is typically performed if the tendon continues to be painful. The MRI can help look at the soft tissues and determine if the achilles tendon is inflamed or torn. The MRI can also help us see if there is an inflamed bursa, or some other soft tissue pathology occurring.

10. If the previously mentioned conservative methods are unsuccessful at relieving the pain, then surgery may be warranted. Surgery on the back of the heel can involve the following: Debulking of the achilles tendon or trimming away of the disease portions of the tendon, removal of the bone spurs on the back of the heel, removal of the bursa, lengthening of the achilles tendon.

Recovery from surgery on he back of the heel is slow and relatively drawn out. If extensive surgery is performed, the patient will often be non-weightbearing on the foot for 4-8 weeks, following partial weightbearing in a boot and then graduate to full weightbearing in the boot and then transition to a normal shoe. Maximally, recovery from achilles tendon surgery takes 3-4 months.  Therefore, all conservative treatments must be exhausted prior to surgery.

If you have a spur on the back of your heel and it is causing you pain, please come see Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center for diagnosis and treatment.

Please 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.

Melanoma is a serious and potentially life-threatening skin condition. In the foot, there are basically 4 types of malignant melanoma that can form. This blog will discuss those 4 common types.

1. Superficial Spreading Melanoma – this is the most commonly seen malignant melanoma. It can affect people of all ages and has a tendency to affect females more often. This type of melanoma has irregular borders (not symmetrical), and can range in color from black, brown, blue, pink, red, and white. They will often look like a mole or freckle that appears to grow sideways. The lesion will often become dark, however may fade as the body tries to fight it. This lesion can go bad very quickly.

2. Nodular Melanoma – although not the most common, this melanoma is the most aggressive. This melanoma is most often sen in people age or 60 or older. This melanoma grows more vertically down into the skin while the diameter of the lesion stays more or less consistent. It usually appears in an area isolated from other skin lesions, like moles or freckles. These lesion are usually very dark and often bleed or ulcerate.

3. Lentigo Maligna Melanoma – this melanoma usually affects the middle aged or elderly patients who have increased exposure to the sun. This lesion is often mistaken for “liver spots” or “sun spots”, especially on the face. They can feel lumpy and often spread vertically deep into the skin. The will also have irregular borders as well.

4. Acral Lentiginous Melanoma – although the most rare, this melanoma is often found in African Americans and people of Asian descent. These lesion appear on the bottom of the feet, under the toenails and even inside the mouth. This lesion, when on the sole of the foot, looks like a black or tan spot with misshapen borders. When under the toenails, it appears as a dark streak. It may also appear like a wart. People must very careful with this melanoma and look for nails coming off, a big, dark nail streak, or bruises that don’t go away.

If you have an area of your foot or leg that looks suspicious, please come see Dr. Kory Williams DPM, or Dr. Eric Silvers. We will be able to evaluate the lesion, perform biopsies, or refer you to the most appropriate doctor to treat your lesion.

Call 972-542-2155 for an appointment today.