Advanced Foot and Ankle Center Blog

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November 15, 2017
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A subungual hematoma is a collection of blood beneath the nail and is usually from trauma to the nail unit.  This can be from obvious injuries like dropping something on the toe or stubbing it  or it can occur from repetitive microtrauma.  This is usually the case with runners or athletics when the toe is constantly and repetitively hitting the shoe.  A small sore develops beneath the nail plate and bleeds under the nail.  This then forms a blood blister beneath the nail which can be very painful and feel like there is a lot of pressure beneath the nail.  


Treatment options vary depending on the injury and the amount of nail involved that has the hematoma.  If there is any known injury, an Xray may be obtained to rule out a fracture to the underlying bone.  If the hematoma encompasses a small area and the nail is not painful, the area can typically be left alone and the bruising will slowly grow out of the nail.  If there is pain to the area and the hematoma involves a large portion of the nail, the pressure can be relieved by puncturing a small hole in the nail plate and allowing the fluid to drain or the nail is removed in its entirety and allowed to grow back.  This is done under local anesthesia in the office.


If you experience this or any other foot and/or ankle issue, please call us at 972-542-2155 for more information.  

November 09, 2017
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Are you starting to notice your second toe rising up and crossing over your big toe?  If so, you may be suffering from a plantar plate injury or pre-dislocation syndrome.  This usually occurs with a bunion deformity in which the big toe sways over and points torward the lesser toes.  The second toe has no where to go so it begins to rise up and cross over the big toe.  This can also occur without a bunion deformity if there is injury to the plantar plate. 

The plantar plate is a thick ligament on the bottom of your foot that connects the toe to the ball of the foot.  You can develop micro tears in the plantar plate from injury or abnormal foot biomechanics.  If you develop a small tear on portion of the ligament that is closer to the 3rd toe, the opposite portion of the ligament is now tighter and pulls the toe toward the big toe. 

If you have a plantar plate tear, it will most likely be painful at the ball of the foot beneath the 2nd toe and will probably be worse with increased activity or walking barefoot.  After a thorough lower extremity physical exam, an X-ray will be taken to ensure there is no bony pathology to the area.  Sometimes when the plantar plate tears, it takes a small portion of bone that it was attached to with it. 

Treatment of plantar plate tears begins conservatively and varies with orthotics, Non-Steroidal Anti-Inflammatory Drugs (NSAIDS such as Advil, Aleve) , walking boots, Injections  and a special device to wear that holds your  toe pointed downward to help faster healing.  If conservative  treatment fails and the area is still painful, the plantar plate may need to be surgically repaired.  This is performed outpatient at a surgery center. 

At Advanced Foot & Ankle Center, all of our providers have extensive experience with this condition.  If you are experiencing this issue or any other foot or ankle disorder, please call us at 972-542-2155.  

November 09, 2017
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The ankle joint is made up of 3 bones: the tibia, fibula, and talus. The ends of these bones are covered with cartilage and are connected by strong ligaments to form the ankle joint. Cartilage is the smooth surface that allows the joints in our body to glide and function. The ligaments surrounding the ankle joint assures proper alignment and proper function. When either of these components are damaged or worn out, this can lead to arthritis.


The most common cause of ankle joint arthritis is post-traumatic arthritis due to a prior injury such as an ankle fracture or ankle sprain, 2nd most common cause is primary osteoarthritis or wear and tear arthritis. Other less common causes include gout, rheumatoid arthritis, neuropathy, osteonecrosis, hemophiliac.


Symptoms of ankle joint arthritis include pain with weight bearing and decreased motion. Exam findings include joint effusion or swelling, pain with motion or loss of motion, crepitus or grinding with motion, and deformity. X-rays will show signs of arthritis including loss of joint space, sclerosis or increased density of the bone underlying the cartilage, cysts or pockets of bone loss to the bone under the cartilage, as well as angular deformity.


Treatment includes conservative as well as surgical options. Conservative options include activity modification, bracing to immobilize the ankle joint, injections, and NSAIDs for pain control. If conservative treatment fails then surgical options are explored. Surgical treatment options vary based on severity and symptoms. For less severe cases, an ankle arthroscopy may be performed to clean up the joint and remove any spurring surrounding the joint that may be causing pain. This may also be performed along with a new procedure called a subchondroplasty which is a minimally invasive procedure that has shown effectiveness in treating pain and preventing or delaying the need for more invasive surgical options. For more severe cases an ankle joint fusion or ankle joint replacement may be an option.


Ankle joint fusion involves removing the remaining cartilage within the ankle joint and placing screws and/or plates to fuse the joint. Fusing the ankle joint prevents any further motion and thereby any pain associated with arthritis. Despite the inability to move the ankle, many patients lead healthy and functional lives without the pain of ankle joint arthritis.


Ankle joint replacement involves a procedure similar to a knee or hip replacement. This involves replacing the joint with a metal implant and polymer spacer. The advantages of ankle joint replacement is the maintenance of joint motion and function. The disadvantages are that ankle joint replacements are a relatively new procedure. Recent 5-10 year studies of newer generation ankle joint implants have shown good to excellent results, but long term outcomes are still pending. As with any artificial joint, there is increased risk of failure and revision with patients that are younger, higher BMI, and higher activity level. These are compounded by the increased forces within the ankle joint and decreased surrounding muscle and soft tissue compared to the knee or hip.


Your foot and ankle specialist at Advanced Foot and Ankle Center in Mckinney and Prosper TX will perform a thorough examination along with x-rays and other imaging and recommend the best course of treatment. Call us today at 972-542-2155 to set up your appointment!


Look out for our next blog post about Peroneal Tendon injuries, and other related conditions.

A common cause of ankle pain is a condition called osteochondral lesions of the ankle. These are injuries to the cartilage within the ankle joint either due to trauma (such as an ankle sprain or ankle fracture) or microtrauma (repetitive high impact activity).


Symptoms include pain, swelling, and a catching or locking sensation within the ankle joint. X-ray imaging may or may not show a bone fragment within the ankle joint. A CT or MRI may be ordered to further evaluate the osteochondral lesion. The CT or MRI will show the size and extent of the injury.


Treatment varies with the size, extent, and displacement of the injury. Acute injuries or nondisplaced fragments may be treated with a non weight bearing cast for 6 weeks. Displaced fragments or large lesions may require surgery to repair the fragment with a small screw or replace the fragment with a graft. Chronic injuries or small lesions may require arthroscopy and a procedure called microfracture or drilling of the base of the lesion to promote cartilage healing.


Without proper treatment this injury may lead to arthritis of the ankle joint.


Your foot and ankle specialist at Advanced Foot and Ankle Center in Mckinney and Prosper TX will perform a thorough examination along with x-rays and other imaging depending on your symptoms and timeline of injury. Call us today at 972-542-2155 to set up your appointment!


Look out for our next blog post about Ankle Joint arthritis, Peroneal Tendon injuries, and other related conditions.

If you are experiencing pain at the center of your toenail or your toenail is lifting off of the nail bed or it has become thick, then you may be suffering from a bone spur beneath the toenail.  These types of spurs are called subungual exostosis.  These are usually benign bone growths on the top of the bone at the tip of the toe where the nail is.  If the spur becomes large enough, it can push on the nail plate and cause pain.  It can become especially painful with tight shoes.  To diagnose the bone spur an X-Ray is obtained to look for the overgrowth of bone.  Sometimes the bone growth is cartilaginous and will not show up on an X-Ray and an MRI is ordered.  


Conservative treatment involves padding the area, wearing shoes with taller toe box and keeping the nail cut short and thin.  If this does not help, the bone spur can be surgically removed with a small incision at the tip of the toe.  This is performed outpatient at a surgery center.  The portion of bone will then be sent to pathology to ensure that it is benign as there are some types of bone tumors in the foot that are cancerous.  At Advanced Foot & Ankle Center, our providers have experience dealing with these issues and are available to evaluate you for this or any other foot/ankle condition that you may have.  Please call 972-542-2155 for an appointment