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

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.

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.

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.

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.