Hallux Varus
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 in the opposite direction of the 2nd digit. Hallux varus can be a problem 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.
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.
The 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 that is congenital or as a result of a past surgical procedure, please call us for a consultation. Dr. Eric Silvers is well-versed in revisional and reconstructive repair of surgical complications.
Please call 972-542-2155 for an appointment today.
Malignant Melanoma of the Foot and Ankle
ADVANCED FOOT AND ANKLE CENTER
Dr. Eric Silvers
McKinney, Texas Prosper, Texas
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 progress quickly.
2. Nodular Melanoma – although not the most common, this melanoma is the most aggressive. This melanoma is most often seen in people age 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. They will also have irregular borders.
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.
If you have an area of your foot or ankle that looks suspicious, schedule an appointment with the foot and ankle specialists at Advanced Foot and Ankle Center in McKinney and Prosper, Texas.
Call 972-542-2155 for an appointment today.
Hallux Malleus
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 treated 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 two 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. Eric Silvers at Advanced Foot and Ankle Center in McKinney, TX and Prosper, TX.
Call today to schedule an appointment with our team - 972-542-2155.
Pain in the Ball of the Foot
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. Eric Silvers at Advanced Foot & Ankle Center in McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.
How Are Puncture Wounds Treated?
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.
Diabetes: Why Having a Good Diet and Exercise Routine Is Important
Most, but not all, Type 2 diabetic patients are overweight or obese. Oftentimes, when they see the doctor, they are probably lectured about what kinds of foods they should be eating and what types of exercises they should be performing.
Research has shown that when doctors tell patients they need to lose weight in order for the patient to gain control of their blood glucose levels, about half of the patients actually gained weight. This gaining of weight was due to them intially depriving themselves of foods, then binging to satiate their appetites.
Most diabetic patients think that a diabetic diet is geared towards limiting all sugar intake. This includes completely avoiding baked goods, candy, and sodas. It is ludicrous to ask a diabetic to completely avoid these things. Diabetic patients can eat anything that a person who does not have diabetes can eat, as long as they eat a baanced diet and avoid too many carbs. Diabetics need to eat carbs at times when their diabetic medication is working most effectively.
Three servings of carbs are needed per day. This includes beans, grains and vegetables.
Two servings of fruits are needed per day. These should be eate when glucse levels are low.
Proteins are needed daily. Diabetics who have limited their protein intake have shown increased fat storag and lowered muscle strength.
The American Diabetes Association has given diabetics the following guidelines for eating:
1. Cholesterol (<300 mg per day)
2. Saturated Fat (<10% per day)
3. Fat (<30% of daily caloroes)
4. Protein (<20% of daily calories)
5. Fiber (<35 g per day)
Vitamins should be taken daily. Vitamin C, D, and E as well as folic acid should be taken daily.
When exercising, diabetics should follow some simple guidelines:
1. See a cardiologist if over 35 y/o.
2. Check your blood sugar before and after exercise.
3. Always carry snacks such as carns for emergencies.
4. Drink plenty of water.
5. Get proper fitting shoegear.
If you are diabetic, please know that the better you eat and the more you exercise, the healthier you will be and the longer you wil live. Although this sems simple, people often become diabetic because they are doing just the opposite.
If you have diabetes, it is important to have a podiatrist in your regimen of doctors. Please consider Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center as your podiatrists.
Make an appintment today. Call 972-542-2155.
