An elderly gentleman presented to our clinic today complaining of itching, burning and drainage between the toes. Patient states his right and left foot have had this appearance for approximately 1 week duration.

The patient stated he had a long history of athlete’s foot, but has never had it this bad. Patient had applying over-the-counter antifungal and hydrocortisone creams in between the toes. Patient stated that his feet actually looked “pretty good” as compared to the past few days.

The patient was ultimately placed on the following medications:

1. Prednisone orally – a steroid to calm down the inflammation of the area

2. Gris-Peg – an oral antifungal taken 3 times per day

3. Augmentin – an antibiotic to fight any secondary bacterial infection

4. Naftin Gel – a topical antifungal to placed between the toes followed by separation of the toes with cotton balls.

5. Betadine – iodine based products to dry out between the toes

Patient was advised to let his feet air dry for 3-4 hours day and use an oscillating fan to “air out” the feet.

Patient is to return in a week for follow-up. More pictures will be posted as this patient continues to improve. Stay posted.

If you have athlete’s foot, please come see the doctors at  Advanced Foot & Center for treatment.

~Dr. Williams

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155

]]> http://www.advancedfoottexas.com/2010/03/a-case-of-athletes-foot/feed/ 0 http://www.advancedfoottexas.com/2010/02/subungual-exostosis/ http://www.advancedfoottexas.com/2010/02/subungual-exostosis/#comments Mon, 22 Feb 2010 15:04:25 +0000 The Doctors at Advanced Foot & Ankle Center http://www.advancedfoottexas.com/?p=1114 True subungual exostoses arise from the tuft of the distal phalanx. They are composed of mature bone with a fibrocartilaginous cap. Lee et al (2007) noted that half of their subungual lesions were actually osteochondromas arising from the proximal part of the distal phalanx and covered with hyaline cartilage organised as in a growth plate. True exostoses are commonest in young adults with a female predominance. They mainly occur in the great toe, although they also occur in the lesser toes and fingers.

They present with a complaint of pain in the toe, sometimes localised to the nail fold. Sometimes the swelling itself may cause pressure on the shoe. Some have a history of trauma or previous nailbed surgery (which may have been for an “ingrowing toenail’ that was, in fact, the exostosis).

Examination shows a firm swelling under the nail, usually in the medial nail fold. It is usually covered with epidermis, but may be raw or granulating.

The main differential diagnosis is ingrowing toenail, with a nailbed tumour such as melanoma, squamous carcinoma or glomus tumour as a much rarer possibility.

The lesion normally continues to grow so is best removed when diagnosed. This can be done under digital block anaesthesia as a day case. Sometimes the nail fold can be elevated and preserved, but usually it cannot be separated from the lesion and must be sacrificed. Even with careful excision of the whole lesion, the recurrence rate averages about 10%. A few patients require removal of so much nail bed that there is significant post-operative nail deformity, so that plastic nail bed reconstruction may be consdered (Suga 2005).

If you feel you may have a painful subungual exostosis, please see Dr. Kory Williams or Dr. Silvers at Advanced Foot and Ankle Center for treatment.

References

• De Berker DA, Langtry J. (1999). Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140(5): 915-8
• Dalle S e al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156(5):871-4
• Gray RJ et al. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705
• Lee SK et al. Two distinctive subungual pathologies. Subungual exostosis and subungual osteochondroma. Foot Ankle Int 2007; 28:595-601
• Suga H et al. Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg. 2005;55(3):272-5

Madura foot is terrible, destructive infection of the skin and deeper tissues. Oftentimes, the infection can reach deeper tissues such as muscle and bone.

It is noted that different species of fungus or bacteria can cause madura foot.

In the United States, Madura foot is most often caused by an organism called Pseudallescheria boydii. Now that’s a mouth full!

Although Madura foot may occur throughout the world, it is most common in dry, tropical, and rural settings. Therefore, this may not be seen very often in Texas, especially North Texas.

Madura foot is usually painless and has 3 characteristic features:

1. Formation of a nodule or lump at the site where the organism is first received, such as a penetrating injury like a puncture wound.

2. There is noted pus and tunneling into the skin at the site of the wound.

3. There is noted “grains” or “granules” within the drainage.

The infection can cause severe swelling and enlargement of the affected leg or foot. The infection can become painful if bone is involved.

Treatment often involves antibiotics and antifungal medications, but amputation is often the end result.

If you feel you may have Madura foot, please come see Dr. Williams or Dr. Silvers and we can refer to the proper Infectious Disease specialist.

A claw toe is a toe that is contracted at the PIP and DIP joints (middle and end joints in the toe), and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe’s joints to curl downwards. Claw toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe.

Claw toes are classified based on the mobility of the toe joints. There are two types – flexible and rigid. In a flexible claw toe, the joint has the ability to move. This type of claw toe can be straightened manually.

A rigid claw toe does not have that same ability to move. Movement is very limited and can be extremely painful. This sometimes causes foot movement to become restricted leading to extra stress at the ball-of-the-foot, and possibly causing pain and the development of corns and calluses.

Cause

Claw toes result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes.

Treatment and Prevention

Changing the type of footwear worn is a very important step in the treatment of claw toes. When choosing a shoe, make sure the toe box (toe area) is high and broad, and can accommodate the claw toes. A shoe with a high, broad toe box will provide enough room in the forefoot area so that there is less friction against the toes.

Other conservative treatments include using forefoot products designed to relieve claw toes, such as toe crests and hammer toe splints. These devices will help hold down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

Hammertoe Crest Pad

Gel Toe Cap

Budin splint / Toe Straightener

If you feel you may have clawtoes, please come see Dr. Williams or Dr. Silvers for treatment.

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155

Enjoy! Have a great day!

P.S. – These are not recommended to wear.

~Dr. Williams

The shortening of the bone is caused by the growth plate pre-maturely closing before growing out to full length. The cause why this happens is still mostly unknown.

Brachymetatarsia is related to following disorders and syndromes:

• Down’s Syndrome
• Turner’s syndrome
• Pseudohypoparathyroidism
• Psuedo-pseudohypoparathyroidism
• Albright’s syndrome
• Diastrophic dwarfism

Bracymetatarsia usually occurs in females and usually occurs in both feet. X-rays usually confirm the shortening of the metatarsal.

As a child, the deformity is usually asymptomatic. The primary complaint in the younger patient is often cosmetic, and many times these patients are self-conscious about their appearance. Older patients may experience symptoms of pain due to excessive pressure under adjacent metatarsal heads. Increased callus formation in the ball of the foot may be present. Skin, soft tissue, and tendon contractions lead to additional discomfort with the use of shoes.

Treatment of brachymetatarsia may include conservative care, such as an orthotic device to take pressure off the adjacent metatarsal heads. Shoe gear may be modified a possible hammertoe deformity or contracture of a toe.

Definitive treatment requires surgical correction to address the soft tissue contractions as well as the shortened metatarsal. Numerous surgical procedures exist to correct brachymetatarsia such as the following:

• Bone Grafts
• Metatarsal osteotomies
• Distraction of the metatarsal with an external fixator
• Tendon lengthening
• Skin modifications

At Advanced Foot & Ankle, Dr. Williams prefers the procedure in which lengthening of the metatarsal is performed with an external fixator. Below is a picture showing the external fixator on the 4th metatarsal bone allowing distraction of the bone.

Please come see Dr. Williams or Dr. Silvers if you have brachymetatarsia and we can discuss your treatment options.

The address to our facility is as follows:

McKinney Office Location

4501 Medical Center Drive: Suite 300

McKinney,  TX 75069

To schedule an apppointment, please call : 972-542-2155

Prosper Office Location

140 N. Preston Road: Suite 30

Prosper, TX 75078

To schedule an appointment, please call:  972-542-2155

Description

Gangrene of the skin is associated with the loss of blood supply of a particular area. In some instances, it is caused by bacterial infection of an open sore or ulceration. The most common form of gangrene develops in the feet of people with diabetes who also have associated loss of circulation in the feet and toes. Any person with poor circulation can develop gangrene. A sudden onset of pain in the feet or legs associated with a decrease in skin temperature, and color changes to the skin of the feet is a strong indication that there has been a sudden blockage of blood flow to the legs. This condition needs immediate medical attention. People who have diabetes may not experience pain associated with such an event because of a condition called diabetic neuropathy. Diabetic neuropathy affects the nerves of the feet and legs causing a diminished ability to perceive pain, excessive heat, cold, vibration, or excessive pressure. This condition places people who have diabetes at greater risk of injury from any source without their being aware of it. For instance, a patient with diabetes can develop an ingrown toenail, and if they also have diabetic neuropathy, they may not experience the same level of pain as someone without the neuropathy. As a consequence the ingrown toenail can worsen, and become infected without providing the warning signs of pain. If the person with diabetes also has poor circulation, the infection can lead to gangrene of the toe. This situation can ultimately lead to the amputation of the toe, foot, or leg, depending upon how bad the circulation is in the leg.

Treatment

Treatment consists of surgical removal of the gangrene, surgery to improve the circulation (by-pass surgery), hyperbaric oxygen treatment and IV antibiotics.

Severe infections can also cause gangrene. The flesh-eating bacterium called Hemolytic Streptococcus is a rapidly spreading infection. Intense local heat, redness, swelling, fever, and weakness characterize this rapidly developing infection. The infection can start with a small abrasion or injury. This condition requires immediate medical treatment. It can result in amputation and/or death. Treatment consists of surgical removal of the infected tissue and IV antibiotics and supportive care as needed for any failing body functions.

If you have gangrene and are unsure what to do, please come see Dr. Williams and Dr. Silvers for our medical advice and guidance.