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

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.

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.

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.