It is thought that ankle sprains happen about 30,000 times per day and make up about 30% of all sports injuries. An estimated 60% of people who suffer from an ankle sprain never seek professional or podiatric treatment. Half of those people will develop chronic symptoms such as severe ankle pain, swelling, recurrent injury, and instability of the ankle.

Research has shown that low grade ankle sprains develop chronic symptoms just as frequently as high grade ankle sprains. This evidence shows that even mild sprains deserve professional attention.

There is huge debate on how ankle sprains should be treated. There are physicians who believe immobilization is the answer. There are others who feel immobilization is wrong. There are also other doctors who think surgery is the most appropriate answer to repairing severe sprains.

When comparing immobilization to mobilization or “functional treatment”, functional treatment has been shown as the best treatment. This proves true when looking return to work, return to sports, pain swelling, range of motion, and cost.

Early mobilization also reduces the degenerative effects of immobilization. Research has shown there is no benefit to immobilizing lateral ankle sprains and may doctors feel that immobilization should be abandoned except in select patients.

Is surgery the best option? Not always. Journals reveal that early mobilization still provides the fastest recovery of ankle joint mobility with the quickest return to sport. Surgery is only indicated when the individual continues to suffer from recurrent sprains and instability.

How do we treat lateral ankle sprains at Advanced Foot & Ankle Center?

First, if the sprain is fresh and there is a moderate to severe amount of swelling present, the patient is placed into a compression dressing such as an UNNA boot. An UNNA boot is tight compressive dressing comprised cast padding and calamine impregnated guaze. See the picture below:

If the swelling is minimal and no compression is needed, then depending on the severity of the sprain then one of two things is performed:

1. Support with an ASO Ankle Brace

2.  Immobilization in a pneumatic walking boot

Once a short period of immobilization is performed, physical therapy may be implemented to increased range-of-motion, ankle strength, walking or running capabilities and balance.

If the patient continues to have severe pain regardless of immobilization or early mobilization via physical therapy, then an MRI may be warranted to examine the integrity of the ankle ligaments.

If the MRI is performed, and there is evidence of ankle ligament rupture, then surgical intervention may be implemented. Surgery repair of ankle ligaments will be explained in more details by the doctors in the office if warranted.

If you have suffered from chronic ankle instability or have suffered a recent sprain, please come see Dr. Kory Williams or Dr. Eric Silvers at Advanced Foot & Ankle Center for assessment and treatment.

Please call for an appointment today! 972-542-2155

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

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

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.