I personally tell patients to avoid cutting or trimming the calluses themselves. Patients should avoid using razor blades, scissors, or knifes to cut calluses. If the foot gets cut, infection can enter the foot and cause more problems than intended.

Usually there is a reason why people get calluses. It may be from an ill-fitting pair of shoes, a bony prominence, or some other condition. Please allow Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot and Ankle Center evaluate your feet, determine the underlying cause and trim your callus or calluses safely.

Please call 972-542-2155 to make an appointment now!

~Dr. Williams

There are basically 2 ways people develop gout:

1.  Metabolic Gout:  Every person has a “factory” inside their body that makes uric acid. If the “factory” works too hard and too much uric acid is produced, excess uric acid is then redistributed by the blood to the joints and soft tissues. Diets that have a high purine content is usually the primary cause for this particular type of gout.

2. Renal Gout: If a person has normal “factory” and produces a “normal” amount of uric acid, but the kidneys can’t pee the uric acid out fast enough, then uric acid can accumulate in the body.  Primary renal gout is usually due to kidney disease but can also be due to diuretics.

There are basically 2 forms of gouty arthritis:

1. Acute Gouty Arthritis: This type of gout usually affects one joint, has a sudden onset and very painful inflammation. The joint is red, hot, swollen and has excruciating pain. The joint is often stiff and oftentimes the joint is so painful the sheets can’t touch it.

2. Chronic Gouty Arthritis: In this type of gout, people can develop collections of uric acid crystals called tophi or a tophus. These tophi can be deposited in the soft tissues, ligaments, tendons and joints. Sometimes the tophi can poke through the skin and drain a white chalky substance resembling cottage cheese.

The most common areas for gout to manifest are in the great toe joint, the back of the heel where the achilles tendon inserts, the ankle, hand, wrist, elbow and knee.

Treatment of Gout

Medications often used treat gout are the following:

1. Indomethacin – for acute gout inflammation

2. Colchicine – for acute gout inflammation

3. Allopurinol – for people who overproduce uric acid

4. Probenecid – for people who underexcrete uric acid

5. Sulfinpyrazole – for people who underexcrete uric acid

If you think you may have gout and want to have it checked, please come see Dr. Kory Williams and Dr. Eric Silvers at Advanced Foot & Ankle Center in McKinney and Prosper, TX. Call 972-542-2155 for an appointment.

~Dr. Williams

A neuroma is a benign swelling of a nerve that is secondary to trauma or compression. If the swelling of the nerve is chronic, then permanent nerve damage can occur. A very common area for a neuroma to occur is in the ball of the foot.

Neuromas are usually occur due to compression between the metatarsal bones, which are long bones located just behind the toes. Nerves course between the metatarsal bones to provide sensation to the toes. At the base of the digits, the nerve splits into a Y shape and enters the toes. Where the nerve splits into a Y is usually where the nerve gets pinched, causing swelling and ultimately the neuroma. A neuroma can manifest as burning pain, tingling and numbness. It has been shown that by removing the shoe and rubbing the foot, symptoms can be alleviated.

As the nerve continues to swell and become larger, the nerve can create a clicking or poppnig sensation when walking as it moves between the metatarsal bone. The neuroma pain comes and goes and is further aggravated by pinching of the nerve.

The most common region of the foot to develop a neuroma is between the 3rd and 4th toes, but also between the 2nd and 3rd toes. Neuromas can occur in both feet or just one foot.

Neuromas are diagnosed by a thorough history and physical exam. Neuromas can often be mistaken for arthritis, stress fractures, avascular necrosis, capsulitis, etc.  X-rays are taken to rule out the previously mentioned problems. X-rays do not show neuromas. Sometimes, special exams such as MRI or nerve conduction studies must be performed to help with the diagnosis.

Treat for neuromas usually consistent of one if not several of the following:

1. Corticosteroid injections

2. Orthotics

3. Chemical destruction of the nerve

4. Surgery

If you think you have a neuroma, please contact Advanced Foot & Ankle Center and schedule an appointment with Dr. Kory Williams or Dr. Eric Silvers.

We are highly trained in the treatment of this problem and we can help you.

Have a nice day!

~Dr. Williams

Best Running Shoe for Summer 2010

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 Dr. Williams & Dr. Silvers 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

Subungual hemoatomas develop because the arteries in the nailbed (the tissue between the nail plate and the bone) get damaged. There is a potential dead space or vacant space that can form between the nail plate and the nail bed, which can fill with blood.

The pressure from the blood under the nail can cause severe pain.

Most patients present with with a swollen toe and complaints of throbbing pain following injury. The 2 most common mechanisms are repetitive microtrauma from sports such as running or tennis or direct trauma from a crush-type injury.

When looking at the nail plate, if the blood takes up more than 25% of the nail plate, then a fracture of the bone underneath usually occurs.

Treatment involves draining of the blood to relieve the pressure. Hematomas involving less than 25% of the nail plate are usually drained by poking a hole through the nail plate with a heated paperclip, a needle, or a hand-held cautery tool. Once the nail plate is penetrated, the blood under the nail is expressed using slight pressure. The area should then be cleansed a dressed with a sterile dressing.

When the blood collection involves more than 25% of the nail plate, there is increased risk of nail bed laceration. Therefore, complete removal of the nail is required in order to properly evaluate the entire nailbed.

Decompression of a subungual hematoma is quick, easy and painless. Patients feel immediate relief and generally have no complications following prompt drainage. Usually the nail will come off on its own in approximately 6 weeks after the trauma, and a new nail is regrown by 6-9 months without being disfigured.