Advanced Foot and Ankle Center Blog

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January 24, 2018
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Nail plate injuries occur due to direct trauma to the toe typically from stubbing the toe onto furniture or dropping an object on the toe. Common injuries associated with nail plate injury are subungual hematoma, nail bed laceration, and nail avulsion.

Subungual Hematoma

A subungual hematoma occurs from injury to the toe and toe nail. The injury causes the nail bed to bleed trapping blood deep to the toe nail. Without treatment the trapped blood under the toe nail causes pressure, pain, or worse, infection. Treatment depends on how much of the toe nail is affected. If less than 50% of the toe nail is affected, a sterile needle is used to puncture through the toe nail thereby releasing the trapped blood. If greater than 50% of the toe nail is affected, the nail plate is removed along with repair of laceration is performed under local anesthesia. Depending on severity and possible infection, a short course of antibiotics may be prescribed.

Nail Bed Laceration

Lacerations to the nail bed typically occur either through an intact toe nail or when the hematoma is greater than 50%. Under local anesthesia the toe nail is removed and the laceration is repaired with suture. A short course of antibiotics may be prescribed.

Nail Avulsion

A nail avulsion occurs when the toe nail is lifted up either partially or completely after an injury. When the nail lifts up it can damage the nail bed and/or the nail root. Treatment depends on the severity of the injury. If the injury is severe with a laceration then treatment is the same as a nail bed laceration. If the toe nail is only partially lifted with no other injury such as a laceration, treatment typically involves pushing the lifted toe nail back down in contact with the nail bed. This may allow the toe nail to grow normally without incident or sometimes the toe nail will fall off on its own and a new toe nail will grow. Sometimes the damage may cause the new toe nail to grow thick or have a split. With these injuries, it is difficult to determine the damage to the nail root at the time of the injury.

If you or a family member injured their toe nail, call us today and make an appointment with our foot and ankle specialists!

Advancedfoottexas.com
(972) 542-2155
January 22, 2018
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Stress fractures are a common overuse injury in athletes and weekend warriors of all ages. Stress fractures occur due to fatigue from repeated stress such as running or jumping over time. This is in contrast to “normal” fractures from a sudden severe impact or twisting motion.

Where and why do they occur?

Stress fractures most commonly occur in the tibia (shin bone), fibula (ankle bone), navicular (foot bone), and metatarsal (bones behind the toes). The pain is typically brought on by a rapid increase in exercise such as sports, running, or jumping. In the early stages, pain is present during activity but subsides with rest. In later stages or more severe stress fractures, pain may be present with any weight bearing activity. If left untreated the stress fracture may even displace, similar to a “normal” fracture, and require surgery.

Diagnosis

Your foot and ankle specialist at Advanced Foot and Ankle Center in Mckinney and Prosper will perform a thorough history and physical exam. X-rays during the early stage may show a faint line or “hairline fracture”. After 3 weeks from onset of pain, x-rays may show bone remodeling and healing with what is called callous formation.

Treatment

Stress fractures are typically treated by immobilization, partial weight bearing, and modification of activity. Your foot and ankle specialist may order a pneumatic cam boot to immobilize the foot, protect the stress fracture, thereby allow healing. For more severe and rare cases, complete non weight bearing may be necessary.

If you or a family member show the signs and symptoms of a stress fracture, call Advanced Foot and Ankle Center of Mckinney and Prosper to schedule your appointment!

Advancedfoottexas.com
(972) 542-2155

Many people visit our office for pain to the back of the heel.  Usually the pain is gradual and there is no trauma that they can remember.  There may even be a bump that they can feel.  Most of the time, this pain is due to inflammation of the achilles tendon and/or a spur on the back of the heel.  This is usually due to having too short of an achilles tendon.  The tendon becomes inflamed where it inserts into the back of the heel bone if it is constantly being strained because it is too short.  Eventually, if the achilles continues to pull on the back of the heel bone, you will develop new bone formation in the direction of the pull which looks like a spur coming from the back of the heel.  Not only is the Achilles tendon inflamed and painful but now the spur is prominent and hurts with pressure.  After a thorough lower extremity physical exam , we will usually take xrays of the affected foot to evaluate for spurring, calcifications within the achilles tendon or any other bony pathology we may suspect.  Treatment begins conservatively and usually starts with  anti inflammatories, aggressive stretching exercises for the short achilles tendon and heel lifts to provide some slack for the tendon.  Other conservative treatment modalities including K-Laser treatment, Physical Therapy, short course of oral steroids and walking boots.  If conservative options fail, surgery may be needed which includes lengthening the achilles tendon and removing the spur from the back of the heel.  At Advanced Foot & Ankle, all of our providers have experience dealing with this issue.  If you suffer from this or any other foot/ankle disorder, please call us at 972-542-2155 for an appointment.

January 18, 2018
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The Achilles tendon is the thick tendon at the back of the leg. It is the thickest tendon in the body and attaches the calf muscles to the calcaneus (heel bone). The achilles tendon’s main function is plantarflexion of the foot at the ankle joint such as with walking, running, and jumping. The three most common painful conditions affecting the achilles tendon are Achilles Tendinitis, Insertional Achilles Tendinitis, and Retrocalcaneal Bursitis/Haglund Deformity.

Achilles Tendinitis

Signs and symptoms of achilles tendinitis are pain, inflammation, and sometimes thickening of the tendon. The pain may be located at 2 different locations; at the insertion where the tendon connects to the heel bone or higher up behind the ankle. Pain is typically aggravated by weight bearing activity, running, jumping, and direct pressure.

Retrocalcaneal bursitis/Haglund’s deformity

Signs and symptoms of bursitis or Haglund’s deformity include pain, inflammation, and a painful bump to the back of the heel where the tendon inserts into the heel bone. Pain is typically aggravated by activity and direct pressure from shoe gear.

Treatment

Treatment includes NSAIDs for pain and inflammation control, rest, ice, and a heel lift to decrease the stress. If the achilles tendinitis is not at the insertion and higher behind the ankle, studies have shown great results with the Alfredson eccentric exercise protocol. In more severe conditions that are not treatable or do not respond to conservative treatment then an MRI may be ordered to determine if there are any tears present in the tendon. Tears in the tendon or conditions that do not respond to conservative treatment may respond to a new treatment called amniotic injection therapy. Severe conditions may require surgical intervention.

Your foot and ankle specialist at Advanced Foot & Ankle Center in Mckinney and Prosper TX will perform a thorough history and physical exam. They will order any necessary X-rays and/or MRIs. A treatment plan will be outlined to get you back on your feet pain free as quickly as possible.

If you have achilles tendon, ankle, and/or heel pain then call us at (972) 542-2155 to schedule your appointment today!

Advancedfoottexas.com
(972) 542-2155

Having a foreign body in the foot is a common problem we see in the office.  Most commonly the issue is a splinter or a piece of glass.  There are many other foreign bodies that we have removed including portions of a nail, metal wiring, sea urchin spine, portion of sea shells, animal hair and dishware as well as insulin needles.  If you think you have a foreign body, avoid “digging” at it at home because you can easily push it in further and make your condition worse.  If the foreign body is deep in your foot, it can wall itself off and form an abscess that can become infected.  When you see us in the clinic for a suspected foreign body, we will perform a thorough lower extremity physical exam.  If the foreign body is superficial, we can remove it in the clinic either with or without local anesthesia.  If there is deep or multiple foreign bodies than you may need to have a procedure at a surgery center under anesthesia to safely remove the pieces.  We will also prescribe appropriate antibiotics if needed and give you bandaging instructions.   If you are experiencing this or any other foot and/or ankle issue, please call us at 972-542-2155 to be evaluated.  We have same day and walk in appointments available.