Jennifer Grey's Neuroma

Dirty Dancing and Dancing with the Stars Jennifer Grey suffered from a painful neuroma that ultimately had to be removed.

Neuromas are essentially swollen nerves that are caused by irritation from adjacent bones (metatarsals). In active people, the neuromas can become very painful and can limit activity if not treated.

Treatment options include cortisone and sclerosing alcohol injections, nerve decompression, padding, non steroidal antiinflamatory medications, orthotics and surgery.

Dr. Silvers has been in practice for over 13 years and treats patients with neuromas on a daily basis.


Eric M. Silvers, DPM, PA is a Board Certified Foot and Ankle Specialist with Advanced Foot and Ankle Center in McKinney, Texas and Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Charity Foot and Ankle Clinic

On February 25, 2011 Dr. Eric Silvers, Dr. Kory Williams and the Staff at Advanced Foot and Ankle Center in McKinney and Prosper, Texas will host a "Charity Foot and Ankle Clinic."
The hours of the free clinic will be 1 pm to 5 pm. The clinic will be open to all uninsured residents in McKinney, Allen, Frisco, Plano, Prosper, Princeton, Farmersville, Mellissa, Anna, Parker, and Van Alstyne, Texas.
Appointments are not necessary but come early since we will see people on a first come first serve basis.
Dr. Williams and Dr. Silvers will be happy to evaluate your feet and address any non emergent foot and ankle issues. Unfortunately, emergencies will not be seen during the free clinic.
"We want to thank the community by giving back," says Dr. Eric Silvers, a Board Certified Foot and Ankle Specialist.
Dr. Silvers has been in practice in Mckinney and the Surrounding area for over 13 years.
Eric M. Silvers, DPM, PA is a Board Certified Foot and Ankle Specialist at Advanced Foot and Ankle Center with offices located in McKinney, Texas and Prosper, Texas.
Dr. Kory William is also a foot and ankle specialist associated with Dr. Eric Silvers and Advanced Foot and Ankle Center.
http://www.advancedfoottexas.com
Our Office Phone Number is 972-542-2155

Poor Circulation in the Foot and Ankle

How Do I Know If I Have Poor Circulation?
How does a diabetic know if they have poor circulation in their feet?
There is an increased incidence of peripheral arterial disease in diabetics. Peripheral arterial disease (PAD) is narrowing or blockage of arteries that results in poor blood flow to your legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps. Peripheral arterial disease is also called peripheral vascular disease or simply poor circulation.Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause symptoms, so many people can have PAD and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.
One in every 20 Americans over the age of 50 had PAD and it is estimated that over 8 million are undiagnosed. Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.
The exact cause of plaque buildup in the limbs is unknown in most cases. However, there are some conditions and habits that raise your chance of developing poor circulation.
Your risk increases if you:
1. Are over the age of 50.
2. Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of P.A.D.
3. Have diabetes. One in every three people over the age of 50 with diabetes is likely to have PAD.
4. Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
5. Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs.
6. Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having PAD.
7. Are African American. African Americans are more than twice as likely to havePAD as their white counterparts.
What are the symptoms of PAD?
Most patients with PAD have little or no symptoms until the disease is advanced; that’s why screening exams are so important. Those who do experience symptoms have reported these typical signs and symptoms:
Claudication: fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away once the activity is stopped and during rest.
Rest Pain: pain in their legs at night that often disturbs their sleep
Wounds or sores that heal very slowly or not at all
Color changes to the skin of their feet and lower legs
Cold, pale feet and legs
Decreased hair and nail growth on their feet
How is PAD Diagnosed?
Your podiatrist will start with checking the pulses in your foot and ankle, examining the skin for changes and wounds that are poorly healing. Often an ABI (ankle-brachial index) is evaluated which compares the blood pressure in your arms to your ankles. A Doppler exam may be ordered. This test uses sound waves to measure the blood flow in the veins and arteries in your arms and legs. If any of these exams are abnormal, your podiatrist may refer you to a vascular surgeon to discuss options for treatment.
How is PAD Treated?
The overall goals for treating PAD are to reduce any symptoms, improve quality of life and mobility, and prevent heart attack, stroke, and amputation. There are three main approaches to treating PAD: making lifestyle changes; taking medication; and in some cases, having a special procedure or surgery. Your physicians will determine the best treatment options for you, based on your medical history and the severity of your condition.
How Can I Prevent PAD If I am Diabetic?
The cornerstone of prevention is lifestyle changes.
Exercise is very important and you should aim for 30-45 minutes of moderate intensity exercise each and every day.
Stop smoking immediately and ask your doctor for help if you find you cannot.
Keep your cholesterol and blood glucose levels down. Aim for a HgA1C of 6!
Keep your blood pressure in the normal range.
Decrease stress.
If you are overweight or obese, aim for a normal weight and again, ask your doctor for help! A diet low in saturated fats, trans fats and cholesterol is also helpful.
More than anything, talk to your doctors about a comprehensive treatment plan for your diabetes that also decreases your PAD risks.
One in every 20 Americans over the age of 50 had PAD and the incidence is higher in diabetics. Most patients have little or no symptoms until it is too late! Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Foot pain from Gout

Gout used to be known as the disease of kings. Too much red meat and red wine caused the kings of old to suffer from gout. This is actually only one cause of gout, but an important safety tip! Gout is a disorder that results from a build up of uric acid crystals in a joint. This can be your big toe joint, ankle, or knee, most commonly; but can occur in any joint or tissue in the body. (I’ve seen it in an earlobe!) Simply said, gout hurts so bad you don’t even want a sock or sheet on your foot, let alone a shoe!
What causes gout?
Gout is a buildup of uric acid crystals in the joint or tissue. Uric acid is normally found in the blood and eliminated by the kidneys. Gout attacks are caused by either too much uric acid in your blood due to the kidneys having trouble eliminating it or simply you just make too much. Gout attacks the big toe joint most commonly, because uric acid turns to crystals as it cools down, and your big toe joint is the furthest from the heart, so the coolest joint in the body. (I always thought big toes were cool!) Seriously though, many people inherit the tendency to have gout and it is much more common in men than women. Other factors that precipitate gout can be high blood pressure, diabetes, obesity, surgery, chemotherapy, stress and certain medications. Food can cause gout attacks. Uric acid is the result of the breakdown of purines, so food with high levels of purines can cause gout. These included red meat, red wine, beer, shellfish, and organ meat. (I knew there was a reason I never liked liver and onions, it causes gout!).
Please see the following website for advice on which foods to avoid and foods to enjoy:
http://arthritis.about.com/cs/goutdiet/a/goutpurines.htm
The diagnosis of gout requires an extensive physical exam including family history, x-rays and laboratory tests for uric acid levels. It is important to distinguish gout from an infection or other inflammatory joint problem.
Treatment for gout starts with anti-inflammatory medication or injection therapy, padding and shoe gear modification. Dietary restrictions are discussed and often a long-term medication is needed to control the build up of uric acid in the blood. In a large, long-term prospective study of men aged 40 years and older, long-term caffeinated coffee consumption was associated with a lower risk for incident gout, so if you fall in this category, this may help as well. Gout can cause degenerative arthritis, so often orthotics or surgery is needed to treat the arthritic joint.
If you have the symptoms of gout, do not delay. The longer the uric acid is accumulating in your joint, the more destructive the crystals can be. Long-term outcomes hinge on immediate care. Call or contact the office today to schedule an appointment with Dr. Williams or Dr. Silvers today.

Eric M. Silvers, DPM, PA
Kory D. Williams, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

New Website

Advanced Foot and Ankle Center, the office of Dr. Eric Silvers and Dr. Kory Williams has a new website. www.advancedfoottexas.com

Dr. Silvers and Dr. Williams are foot and ankle specialists trained to treat all foot and ankle conditions. With offices in McKinney and Prosper, Texas, we assure you that we are close by.

We serve McKinney, Propser, Frisco, Allen, Anna, Melissa, Plano, Princeton and surrounding areas.

Please visit our website and call 972-542-2155 to set up an appointment.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Christmas in Iraq 2009

The doctors and staff at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are happy to be the Organizers of Christmas in Iraq 2009. Please visit the blog site at http://christmasiniraq2009.blogspot.com to learn how you can help.


Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Short Toe, Brachymetatarsia

Brachymetatarsia is a congenital condition where one of the metatarsals are shorter than adjacent metatarsal that cause one or more toes to look shorter. Most of the time this condition does not present a problem. Other times it can cause pain. Treatment includes padding, change of shoe gear and also surgery. The surgeons at Advanced Foot and Ankle Center are trained to treat Brachymetatarsia both conservatively and surgically.

Most procedures are done in an outpatient setting. We typically will perform our procedures at Craig Ranch Surgery Center or at Craig Ranch Hospital.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

New Blog Page for McKinney Podiatrists

Dr. Kory Williams, a foot and ankle surgeon with Advanced Foot and Ankle Center has just created a new Blog for our office. Please visit it at http://advancedfoottexas.blogspot.com/

Dr. Williams joins Dr. Eric Silvers in Practice. Both surgeons serve McKinney, Prosper, Allen, Anna, Frisco, Plano and surrounding communities.

Call our office at 972-542-2155 or visit our website for an appointment.


Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Prosper Podiatrist to Expand Office Hours

Dr. Eric M. Silvers and Dr. Kory D. Williams of Advanced Foot and Ankle will be expanding their office hours in Prosper, Texas. Both foot and ankle specialists see patients in their McKinney, Texas and Prosper, Texas locations. As surgically trained foot and ankle specialists, Dr. Silvers and Dr. Williams consider their skilled approach to foot and ankle conditions as inclusive, gentle and skilled.

Dr. Silvers and Dr. Williams will soon be offering Tuesday Morning and Wednesday morning appointments in their Prosper, Texas Location.

To schedule an appointment, call 972-542-2155 or visit out website at www.advancedfoottexas.com .

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Diabetic Specialist Discusses Foot Ulcers

Foot Ulcers: What To Do If You Have One

When using the term "ulcer", we are generally referring to a break or hole in the the skin. Ulcers are skin wounds can be slow to heal and are classified in four stages, according to which layers of skin are broken through. Stage 1 ulcers are characterized by a reddening over bony areas. The redness on the skin does not go away when pressure is relieved. The area is not an open sore, but the patient can be predisposed to having an ulcer at the site. Stage 2 ulcers are characterized by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the superficial layers of the skin. Stage 3 ulcers are characterized by broken skin and sometimes bloody, watery, or creamy drainage. There is a usually complete loss of the skin along with some of the subcutaneous tissue, which includes the fat layer under the skin that holds the blood vessels and nerves.
Stage 4 ulcers are characterized by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.How an ulcer feels is dependent on the underlying cause of the ulcer. For example, one of the more common types of ulcers is seen in patients with diabetes, who have loss of sensation in their feet. In this type of ulcer, there is little if any pain, due to a condition called diabetic neuropathy. In fact, diabetics typically get this type of ulcer because they've lost their protective pain sensation. Another common ulcer is due to loss of arterial blood flow to the leg, resulting in ischemic ulcers that can be very painful. So you can see that it very important to have any break in the skin properly evaluated and the lack of pain is not always a good initiator as to the severity of the problem. There are many different diagnostic tests that can be done in the course of treating an ulcer. If the ulcer appears to be infected, and the patient has redness, drainage, swelling, and pain, then a culture of the wound should be done. The reason for the culture is to identify the type of infection, so that you can be put on the appropriate antibiotic. If there is suspicion of the bone being infected under the ulcer, the doctor will do x-rays and other imaging modalities to determine the extent of the infection. If there is suspicion that the underlying reason for the ulcer is poor blood flow, then a studies to look at you blood vessels can be done. Ulcers occur due to different reasons, so it is very important to determine the underlying medical problem that caused the ulcer. There are essentially four main reasons people get ulcers on the foot. Neuropathic Ulcers: This is when a patient has loss of sensation in the feet. It is commonly seen in people with diabetes but it can be caused by other reasons such as chronic alcohol abuse. These ulcers are generally seen under weight bearing areas and often will begin as a callus or a corn. Arterial Ulcers: This type of ulcer is due to poor blood flow to the lower extremity. This type of ulcer can be very painful and are usually found on the tips of toes, lower legs, ankle, heel and top of the foot. They can very easily become infected. Venous Stasis Ulcers: This type of ulcer is due to poor veins. Veins are the vessels that take fluid out of the legs and back up to the heart. Veins have small valves that allow blood to flow only one way, back up to the heart. The valves normally block the tendency for gravity to pull the blood back down to the legs. Sometimes the valves leak or cease to work at all. If the valves do not work, then the fluid pools down in the legs, causing swelling. This swelling leads to increase pressure in the venous system, producing discoloration of the leg and eventually this lead to ulceration. They are commonly seen around the inside of the ankle and are slow to heal. Decubitus Ulcers: This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels. The best thing you can do for an ulcer is to have it looked at by your doctor, as soon as you can. The earlier that the ulcer is treated, the better chance you have at healing it.The first thing that will be done is to inspect the wound. The doctor is looking for signs of infection, location of the wound, the color of the tissue in the wound. This is all done to determine the best treatment for that wound. Once the cause of the ulcer is determined and all the necessary referrals are made, treatment of the ulcer can begin. The treatment will be tailored to the individual ulcer and it is often difficult to predict how long it will take an ulcer to heal. Sometimes patients have to be referred to a vascular specialist if the ulcer is due to poor blood flow. Sometimes a patient has to be sent to their diabetes doctor to get their blood sugars controlled. It takes a careful thought process by the podiatrist to determine the underlying etiology of the ulcer and point the patient in the right direction.
The best prevention is treating the underlying cause of the ulcer. That means if you are a diabetic, check your blood sugar daily and inspect your feet every day. If the reason for your ulcer is due to swelling in the legs, then you need to wear support stockings and keep your feet elevated as much as possible. If the ulcer is due to poor blood flow, treatment may be rendered to get more blood flow and oxygen to your feet. If the ulcer is due to pressure, finding ways to relieve that pressure is required.

Dr. Eric Silvers and Dr. Kory Williams see ulcerations daily and are well trained to treat all foot and ankle conditions. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Texas Foot Doctor Discussed Orthotics

Advanced Foot and Ankle Center
Eric M. Silvers, DPM, PA
4501 Medical Center Drive, Suite 300
McKinney, Texas 75069
170 N. Preston Road, Suite 30
Prosper, Texas 75078
972-542-2155
www.advancedfoottexas.com

About Custom Orthotics

What is a custom orthotic?
A custom molded foot orthotic is a custom-made three-dimensional foot brace that is inserted in your shoe to help the pain and discomfort caused by the weakness and instability and/or deformity of your foot.
Orthotics work by decreasing high-pressure areas, stabilizing foot alignment and/or cushioning the foot. They also help to stabilize your foot during the walking cycle. Orthotics will not permanently change your anatomy and will function only when you are standing or walking on them.
Orthotics commonly used to relieve symptoms of common injuries, such as plantar fasciitis, metatarsalgia, neuromas, and various foot and ankle tendon injuries, as well as helping individuals with diabetes or arthritis. Orthotics complement other treatments such as physiotherapy, stretching, icing, and massage and at time foot and ankle surgery
.
How will the orthotics feel at first?
When you first wear your orthotics, it is normal for the orthotics to feel strange; however, properly fitting orthotics should not cause any new pain, blistering or redness. If this does occur, remove the orthotics and make an appointment with your Dr. Silvers or Dr. Williams for an adjustment.
Although symptomatic relief will not occur over night, consistently wearing your orthotics for a period of time will realign your foot and allow healing to occur.

How do I take care of my orthotics?
To clean your orthotics, wash with warm water and mild soap and air dry. Do not expose them to high heat.

Are Orthotics Adjustable?

Yes, depending on the adjustment needed, it can be performed either in the office or by sending the orthotic back to the lab that fabricated the device.

Are Custom Orthotics Covered By Insurance?

Orthotic coverage does vary from insurance plan to insurance plan. Our staff will do our best to find out if orthotics are covered under your plan. Please be aware that we can only forward the coverage information to you that the insurance company gives to us. This is not a guarantee of coverage since the insurance company cannot guarantee benefits until the claim is processed. If you are concerned if your insurance company covers custom molded foot orthotics, we urge you to call your insurance company to confirm coverage or non coverage. The billing code for custom molded foot orthotics is L3000. Please feel free to always ask our staff if you have any questions or concerns. We are here to help you and our primary concern is your complete satisfaction.
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Heel pain in Children

Heel pain is one of the most common conditions that we see here at Advanced Foot and Ankle in McKinney and Prosper, Texas. Many of our heel pain patients are children. Now, pain in the heel is not normal. It is your body's way of saying to you, "hey, I am not feeling very well down here!" With that being said, pediatric heel pain should not be ignored.

Your child often will complain of pain along the back and/or bottom of the heel or heels and you may see him or her limping or walking on their toes. Often times the heel pain is present during and/or after activity.

The most common cause of pediatric heel pain is a condition called "Calcaneal Apophysitis" or "Sever's Disease." This typically effects kids between the ages of 8-14 years old. This is not the only cause of pediatric heel pain. Other causes can be a fracture, contusion, infection, warts, callouses and in rare cases a tumor.

Pediatric heel pain does differ from heel pain seen in adults. Heel pain seen in adults is often "Plantar Fasciitis" which is a condition that causes inflammation of a long ligament called the Plantar Fascia that runs from the heel bone to the soft tissues behind the toes. Plantar fascia pain is worse after rest (in the morning after rising from bed or after sitting for a while). In the case of Pediatric Heel pain, the pain often increases with activity such as walking and playing sports. Heel pain in kids is common due to the fact that the heel is still growing. The heel bone is not fully developed until the child is 14. There is a growth plate (called the apophysis) along the back of the heel. If the the apophysis is stressed, heel pain will begin due to inflammation. The Achilles tendon inserts along the back of the heel behind this growth plate, and because of this, its aggressive pull on the heel often irritate the growth plate.

It is important to seek treatment at Advanced Foot and Ankle in McKinney and Prosper, Texas for pediatric heel pain since there are more than once cause of pediatric heel pain. Causes include Calcaneal Apophystitis as discussed, Tendo-Achilles bursitis which is a condition in which a sac of fluid between the achilles tendon and the heel bone becomes inflamed. Causes of bursitis can be inflammatory conditions such as arthritis, poor footwear or trauma.

Overuse syndromes can also cause pediatric heel pain. Overuse syndromes typically are seen in kids older than 14 years old. They may suffer from tendinitis of the Achilles Tendon, or less common, plantar fasciitis.

Fractures of the heel can also be seen in kids. Stress fractures are small hairline fractures that are seen more often in teenagers that are active in athletics. Stress fractures are often associated with increased activity. Acute fractures are seen as a result of trauma such as jumping off a piece of furniture, stairway, fence or roof. Heel fractures can be very serious and medical attention should be sought out immediately.

Treatment of pediatric heel pain is often initiated by seeing one of the Podiatrists at Advanced Foot and Ankle. A thorough extremity exam will be carried out follow by X-rays. Sometimes a MRI or CT scan may be necessary. Blood work may also need to be order to rule out arthritic inflammatory conditions or if an infection is suspected.

Treatment depends on the diagnosis and the intensity of the pain. Rest or reduced activity is often suggested. Our doctors may suggest that the child refrain from high impact activity including running and/or jumping. Heel lifts, night splints and/or walking cast immobilization may also be entertained as treatment options. Anti inflammatory medications, physical therapy and custom molded foot braces (orthotics) are other ways of treating pediatric heel pain. On rare occasions surgery may be needed, especially if the child has a short heel cord.

Can anything be done to prevent pediatric heel pain? Yes, shoe gear such as avoiding cleated shoes, avoiding obesity, choosing well constructed shoes that coincide with the patients activity and avoiding activity that may be too aggressive for the child's physical ability.

Dr. Eric Silvers and Dr. Kory Williams see pediatric heel pain daily and are well trained to treat all foot and ankle conditions seen in children. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas.com/ .

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Achilles Tendon Pain?

Thanks for visiting our blog on this week's topic...."Achilles Tendon Problems." We hope you find it informative.

Achilles Tendon Injuries & Problems

Problems that affect the Achilles tendon include tendonitis, tendinopathy, retrocalcaneal bursitis, and tendonosis. Each of these conditions will be described and explained. These problems affect athletes most often, especially runners, basketball players, and anyone engaged in jumping sports. They are also common among both active and sedentary (inactive) middle-aged adults. These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon.

Anatomy of the Achilles Tendon

The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleal muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.

Retrocalcaneal Bursitis

A bursa is a fluid-filled sac designed to limit friction between rubbing parts. It acts like a pillow between the heel bone or calcaneus and the achilles tendon. These sacs are found in many places in the body. When a bursa becomes inflamed, the condition is called bursitis. Retrocalcaneal bursitis is an inflammation in the bursa behind the heel bone. This bursa normally limits friction where the thick fibrous Achilles tendon that runs down the back of the calf glides up and down behind the heel.

Achilles Tendinitis

A violent strain can cause trauma to the calf muscles or the Achilles tendon. Sometimes this is referred to as tendonitis. This injury can happen during a strong contraction of the muscle, as when running or sprinting. Landing on the ground after a jump can force the foot upward, also causing injury. The strain can affect different portions of the muscles or tendon. For instance, the strain may occur in the center of the muscle. Or it may happen where the muscles join the Achilles tendon.

Achilles Tendinopathy/Tendinosis

Chronic overuse may contribute to changes in the Achilles tendon as well, leading to degeneration and thickening of the tendon. Studies show there is no sign of inflammation with overuse injuries of tendons. Most experts now refer to this condition as tendinopathy or tendonosis instead of tendonitis.

Achilles Tendon Rupture

In severe cases, the force of a violent strain may even rupture the tendon. The classic example is a middle-aged weekend warrior who places too much stress on the tendon and experiences a tearing or pop of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.
Problems with the Achilles tendon seem to occur in different ways. Initially, irritation of the outer covering of the tendon, called the paratenon, causes paratendonitis. Paratendonitis is simply inflammation around the tendon. Inflammation of the retrocalcaneal bursa may also be present with paratendonitis. Either of these conditions may be due to repeated overuse or ill-fitting shoes that rub on the tendon or bursa.
As we age, our tendons can degenerate. Degeneration means that wear and tear occurs in the tendon over time and leads to a situation where the tendon is weaker than normal. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon. Tendons are made up of strands of a material called collagen. (Think of a tendon as similar to a nylon rope and the strands of collagen as the nylon strands.) Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength.
The healing process in the tendon causes the tendon to become thickened as scar tissue tries to repair the tendon. This process can continue to the extent that a nodule forms within the tendon. This degenerative condition without inflammation is called tendonosis. The area of tendonosis in the tendon is weaker than normal tendon. Tiny tears in the tissue around the tendon occur with overuse. The weakened, degenerative tendon sets the stage for the possibility of actual rupture of the Achilles tendon.
Retrocalcaneal bursitis usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling in the area. The back of the shoe may further irritate the condition, making it difficult to tolerate shoe wear.
Achilles tendonitis usually occurs further up the leg, just above the heel bone itself. The Achilles tendon in this area may be noticeably thickened and tender to the touch. Pain is present with walking, especially when pushing off on the toes.
An Achilles tendon rupture is usually an unmistakable event. Some bystanders may report actually hearing the snap, and the victim of a rupture usually describes a sensation similar to being violently kicked in the calf. Following rupture the calf may swell, and the injured person usually can't rise on his toes.

Diagnosis

Diagnosis is almost always by clinical history and physical examination. The physical examination is used to determine where your leg hurts. We will probably move your ankle in different positions and ask you to hold your foot against the our hand pressure. By stretching the calf muscles and feeling where these muscles attach on the Achilles tendon, we can begin to locate the problem area.
We may run some simple tests if a rupture is suspected. One test involves simply feeling for a gap in the tendon where the rupture has occurred. However, swelling in the area can make it hard to feel a gap.
Another test is done with your leg positioned off the edge of the treatment table. We will squeeze your calf muscle to see if your foot bends downward. If your foot doesn't bend downward, it's highly likely that you have a ruptured Achilles tendon.
When we are unsure whether the Achilles tendon has been ruptured, an MRI scan may be necessary to confirm the diagnosis. This is seldom the case. The MRI creates images that look like slices and shows the tendons and ligaments very clearly. This test does not require any needles or special dye and is painless.
We may order an ultrasound test. An ultrasound uses high-frequency sound waves to create an image of the body's organs and structures. The image can show if an Achilles tendon has partially or completely torn. This test can also be repeated over time to see if a tear has gotten worse.
By using the MRI and ultrasound tests, we can determine if surgery is needed. For example, a small tear may mean that a patient might only need physical therapy and not surgery.

Treatment

Nonsurgical Treatment

Tendonitis/Tendinopathy

In the past, nonsurgical treatment for retrocalcaneal bursitis and Achilles tendonitis started with a combination of rest, ice, and anti-inflammatory medications such as aspirin or ibuprofen.
If there is an inflammatory process, then the condition should respond fairly quickly to drug and antiinflammatory interventions. Limiting, but not eliminating, inflammation is the new goal.
Physical therapy may be recommended for any of these tendon problems. Treatment will depend on what type of problem (tendonitis or tendinopathy/tendonosis) is present.
Your therapist will know when and how to apply cold modalities to reduce swelling and pain but still allow the healing inflammatory process. Physical therapy for chronic tendon problems may also include a special program of stretching and eccentric strengthening exercises. Your therapist will instruct you in a home care program.
Low-energy shock wave therapy has been used successfully for chronic tendinopathy. The procedure does not require anesthesia but it may take several treatment sessions. The vibration produced by the energy waves is applied to areas of tenderness while the affected foot and ankle are gently moved in all directions. Shock wave therapy works by turning off nerves responsible for pain without affecting motor function. It also stimulates soft-tissue healing by increasing blood supply to the area treated.

Tendinosis
If the problem is one of tendon tissue degeneration, healing and recovery may take longer. The injury will not respond to treatment designed to reduce inflammation. Correct treatment of tendinosis involves allowing new tendon tissue growth and improving the strength of the tendon. Rehabilitation following rupture of the tendon is quite different and is described later.
An acute injury needs rest. This can be done by limiting activities like walking on the sore leg. A small ¼ or ½ inch heel lift placed in your shoe can minimize stress by putting slack in the calf muscle and Achilles tendon. Be sure to place a similar sized lift in the other shoe to keep everything aligned. A cortisone injection is not advised for this condition, due to the increased risk of rupture of the tendon following injection.

Tendon Rupture

Nonsurgical treatment for an Achilles tendon rupture is somewhat controversial. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased in those patients treated with casting for eight weeks when compared with those undergoing surgery. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, we feel that Achilles tendon ruptures in nearly all patients should be surgically repaired.

Surgery

Surgical treatment for Achilles tendonitis is not usually necessary for most patients. Surgery options range from a release of the tendon to a more involved, open approach of repair.
In some cases of persistent tendonitis and tendinosis a procedure called debridement of the Achilles tendon may be suggested to help treat the problem.
This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. The tendon is identified, and any inflamed tissue is removed. The tendon is then split, and the degenerative portion of the tendon is removed. The split tendon is then repaired and allowed to heal. It is unclear why, but removing the degenerative portion of the tendon seems to stimulate repair of the tendon to a more normal state.
Surgery may also be suggested if you have a ruptured Achilles tendon. Reattaching the two ends of the tendon repairs the torn Achilles tendon. This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. Numerous procedures have been developed to repair the tendon, but most involve sewing the two ends of the tendon together in some fashion.

After Surgery

Traditionally, patients would be placed in a cast or brace for six to eight weeks after surgery to protect the repair and the skin incision. Crutches would be needed at first to keep from putting weight onto the foot. Complications can occur such as delayed healing, infection, and scarring. More serious problems such as tendon rupture and nerve damage can also occur.
Passive range of motion exercises during this period help patients maintain good general muscle strength and aerobic fitness. Upon removing the cast, a shoe with a fairly high heel is recommended for up to eight more weeks, at which time physical therapy begins.
Immobilizing the leg in a cast can cause joint stiffness, muscle wasting, and blood clots. To avoid these problems, surgeons may have their patients start doing motion exercises very soon after surgery. Patients wear a splint that can easily be removed to do the exercises throughout the day. A crutch or cane may be used at first to help you avoid limping.

Dr. Silvers and Dr. Williams of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have 5 years combined postgraduate training in foot and ankle conditions including managing achilles tendon problems. They also have over 12 years combined private practice experience in treating all conditions of the foot and ankle.The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are the providers to seek out for treatment not only for achilles tendon problems, but for all of your foot and ankle needs.Advanced Foot and Ankle Services the residents of McKinney, Allen, Plano, Frisco, Prosper, Pilot Point, Little Elm, Melissa, Anna, Celina and surrounding communities. We strive for compassionate and uncompromised foot and ankle care. Our doctors and staff will treat you like family and we respect your busy schedule. Your foot and ankle care is our top priority and we strive to deliver excellent care for all of your podiatric needs. To schedule an appointment to see Dr. Eric Silvers or Dr. Kory Williams of Advanced Foot and Ankle Center , please call us at 972-542-2155 or visit our website at http://www.advancedfoottexas.com/ . We often have same day appointments along with lunchtime, evening and early morning hours.Eric M. Silvers, DPM , PABoard Certified Foot and Ankle SpecialistAdvanced Foot and Ankle CenterMcKinney , TexasProsper, Texashttp://www.advancedfoottexas.com

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Foot Doctor Discusses Flat Feet in Children

Pediatric Flatfoot Deformity

A flatfoot deformity is where the arch on the inside border of the foot is flatter than normal. Flatfoot deformities may occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these individuals have pain related to their flatfoot deformity throughout their lives. It is very important that children with such a deformity be evaluated by Dr. Silvers or Dr. Williams to determine if they need treatment to attempt to prevent future pain or deformity in their feet as an adult.When the young child starts to first walk at about the age of 9-15 months of age, the foot has a "fat" or “chubby” appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity. I have seen many parents bringing their young infant into the clinic, stating, "My child has flat feet. What do I need to do?" Ninety-nine percent of the time, I tell them you should do nothing and stop worrying, because flatfootedness in a child this young is normal and will probably grow out of it. At the ages of two and three, the child’s foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, it is wise to have the foot examined by a foot specialist like Dr. Silvers & Dr. Williams. At this age, the foot is still largely made of cartilage, with less bone than is present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.The flatfoot deformity in children causes a number of changes to the structure of the foot which is easily recognizable by the trained podiatrist. Flatfoot deformity causes the inside arch to be flattened, causes the heel bone to be turned outward, and causes the inside aspect of the foot to appear more bowed outward than normal. Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity.Since the flatfoot deformity causes some instability of the foot during gait, children with flatfoot deformity may have complaints in the foot such as arch, heel or ankle pain which is generally associated with increased standing, walking or running activities. However, since the excessive rolling inward of the arches of the foot also make the leg and knee more turned inwards, children with flatfeet may also complain of pain in the low back, hip, knee, or leg due to the abnormal mechanics of the foot created by the flatfoot deformity.Pediatric flatfoot deformity can be diagnosed at a very early age, but is unlikely to be properly diagnosed unless the doctor is a foot specialist like Dr. Silvers and Dr. Williams and is familiar with the intricacies of the structure and biomechanics of the foot. After speaking with the parent and child, the podiatrist will examine the foot both while the child is not bearing weight but also while the child is standing, walking or running. Often, the family history is also taken since the foot should be examined closely if the child has a close relative who had a painful flatfoot deformity as a child or adult.During the examination of the child, the podiatrist is looking for abnormal structure or function of the foot and lower extremity, which could lead to problems during later childhood or adulthood. X-rays may be taken of the foot if a significant pathology is noted or suspected. The more severe the flatfoot deformity and the more significant the complaints in the foot or lower extremity, then the more likely Dr. Silvers or Dr. Williams will recommend specific treatment for the flatfoot deformity.TreatmentIf the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by Dr. Silvers and Dr. Williams. If, however, the child has a moderate to severe flatfoot deformity and does have significant symptoms in the foot or lower extremity, then treatment is indicated.Treatment generally starts with both supportive shoes, such as high tops, and some form of shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by functional foot orthotics. Orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since these muscles can worsen the flatfoot deformity with time and make the child’s symptoms worse.If the child has a severe flatfoot deformity and disabling symptoms which does not respond to foot orthotics, shoes and/or stretching, then foot surgery to correct the flatfoot deformity may be indicated. Flatfoot surgery is done only rarely for those children with the most severe deformities. Of course, the benefits of the surgery should be considered along with the risks associated with the surgery and a second surgical opinion is always recommended when considering flatfoot surgery on your child.The extent of flatfoot surgery depends on the severity of the deformity. Flatfoot surgery is usually not indicated until the patient has reached skeletal maturity and the growth plates have "disappeared". Most child patients having flatfoot surgery are of junior high and high school ages. The procedures most commonly performed by Dr. Silvers and Dr. Williams are a subtalar arthroeresis, gastrocnemius recession or tendo achilles lengthening, Evans osteotomy, and Cotton osteotomy. I know these names and procedures mean nothing to the lay person, however, these procedures are included in need of further research on the internet by the patient or the patient's parents. In most cases, only a couple of the above-mentioned procedures are utilized for flatfoot correction. Only in severe flatfoot cases, would all the above surgeries be implemented.

If you feel that your child needs possible surgical intervention, please make an appointment with Dr. Silvers or Dr.Williams for our professional opinion and detailed explanation of the procedures.

Dr. Silvers and Dr. Williams of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have 5 years combined postgraduate training in foot and ankle conditions including managing arthridies of the great toe joint. They also have over 12 years combined private practice experience in treating all conditions of the foot and ankle.The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are the providers to seek out for treatment not only for your child's flatfoot, but for all of your foot and ankle needs.Advanced Foot and Ankle Services the residents of McKinney, Allen, Plano, Frisco, Prosper, Pilot Point, Little Elm, Melissa, Anna, Celina and surrounding communities. We strive for compassionate and uncompromised foot and ankle care. Our doctors and staff will treat you like family and we respect your busy schedule. Your foot and ankle care is our top priority and we strive to deliver excellent care for all of your podiatric needs.To schedule an appointment to see Dr. Eric Silvers or Dr. Kory Williams of Advanced Foot and Ankle Center, please call us at 972-542-2155 or visit our website at http://www.advancedfoottexas.com/ . We often have same day appointments along with lunchtime, evening and early morning hours.


Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Foot Specialist Discussed Arthritis of the Big Toe Joint

The big toe joint is susceptible to many high stress forces throughout the day. Years of abnormal stresses such as trauma, high impact sports, and systemic arthridities can cause pain, swelling and disfigurement of the joint. This can in turn cause pain to the joint that can lead to pain with each step.

One may present with a swollen, warm and painful joint. The presentation may be short lived or ongoing. Pain with motion and a sensation of grinding or cracking within the joint may also be present. The pain may limit certain activities such as running, jogging or even a brisk walk. Arthritis of the big toe joint may also make it difficult for one to squat or stoop over.

Although many types of arthridities can effect the great toe joint, a McKinney, Texas foot and ankle specialist (podiatrist) is able to narrow down the specific arthridity. Treatment often begins with evaluation of the foot along with x-rays. The doctors at Advanced Foot and Ankle Center in McKinney and Proper, Texas may also choose to have some blood work performed. Oral, topical and injectible antiinflamatory medications are often given to reduce inflammation. A special fracture shoe or boot may be dispensed if the pain is very intense. Once the inflammation is stabilized and if there is a lot of joint destruction noted radiographically and clinically, surgical options may be visited. Dr. Silvers and Dr. Williams of Advanced Foot and Ankle Center in McKinney and Prosper, Texas have 5 years combined postgraduate training in foot and ankle conditions including managing arthridies of the great toe joint. They also have over 12 years combined private practice experience in treating all conditions of the foot and ankle.
The physicians at Advanced Foot and Ankle Center in McKinney and Prosper, Texas are the providers to seek out for treatment not only your arthritic great toe joint problem, but for all of your foot and ankle needs.
Advanced Foot and Ankle Services the residents of McKinney, Allen, Plano, Frisco, Prosper, Pilot Point, Little Elm, Melissa, Anna, Celina and surrounding communities. We strive for compassionate and uncompromised foot and ankle care. Our doctors and staff will treat you like family and we respect your busy schedule. Your foot and ankle care is our top priority and we strive to deliver excellent care for all of your podiatric needs.

To schedule an appointment to see Dr. Eric Silvers or Dr. Kory Williams of Advanced Foot and Ankle Center, please call us at 972-542-2155 or visit our website at http://www.advancedfoottexas.com/ . We often have same day appointments along with lunchtime, evening and early morning hours.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Proper Diabetic Foot Care Should Not Be Overlooked

DIABETIC FOOT CARE

As podiatrists (foot and ankle specialists), Dr. Silvers & Dr. Williams see a large amount of diabetic patients at their McKinney, Texas and Prosper, Texas Office Locations. These patients are usually referred from primary care physicians or endocrinologists, or patients themselves concerned about their foot health come to our clinic. Diabetic patients have to take extra special care of their to prevent ulcerations, infections, and even amputations. Listed below are a few helpful tips for diabetics concerned with how to take proper precautions and protect their feet. Take these steps to help prevent diabetic foot complications:

1. Check your feet everyday! This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.

2. Check your shoes before you put your feet in them. Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?”

3. Don’t walk around barefoot or in sandals. Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.



4. Watch out for folds in your socks. Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration. Avoid cotton socks and choose synthetic blends, polypropylene, acrylic, diabetic socks or small fiber wool blends.

5. Dry off your feet after showers and dry between your toes. Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.

6. Don’t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor. 



7. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your hand. This will be much more accurate than testing the water with your foot.

8. Don’t use a heating pad on your feet. This may cause burns without you realizing it. This has specifically happened to my diabetic grandfather who in result had to receive repeated wound care and eventually a skin graft to bottom of his foot.

9. Do not use medicated corn pads or any medicated pads from the local drug store. These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your podiatrist.

10. Do not cut your own toenails. If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.



11. Do not trim your own calluses or corns. As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or calluses.

12. Lose Weight. Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.

13. Exercise. Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.



14. STOP SMOKING! This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.

15. Visit a podiatrist regularly.

If you have diabetes and are seeking treatment and advice, please come visit Advanced Foot and Ankle. Dr. Silvers is a board certified foot and ankle specialist practicing in McKinney, Texas and Proper, Texas. He sees patients from North Dallas, McKinney, Plano, Allen, Prosper, Frisco, Melissa, Anna and Princeton, Texas. To Schedule an Appointment with Dr. Silvers, please call 972-542-2155 or visit our website at http://www.advancedfoottexas.com

Dr. Kory Williams will be joining McKinney Foot and Ankle and Advanced Foot and Ankle in July of 2009. Both Dr. Silvers and Dr. Williams strive to deliver the utmost quality foot and ankle care with a compassionate bedside manner. Our doctors have 5 years of combined foot and ankle post graduate training and over 11 years of private practice experience. Both Dr. Silvers and Dr. Williams are respected speakers in the field of Podiatric Medicine, Surgery and Practice Management. Dr. Silvers is the Past President of the Dallas County Podiatric Medical Society.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Foot Doctor Discusses Toe Injuries

Injuries to the Toes

Injuries to the great toe or lesser digits (2nd, 3rd, 4th and 5th toes) are quite common. These injuries range from a simple stub of a toe on a piece of furnature to traumatic injuries including machinery injuries and gun shot wounds. Most injuries include fractures most often involving the lesser toes. Fractures to toes can be treated and the injured individual is advised to seek medical attention. If the fracture to lesser digit is in good alignment, then simple buddy splinting along with a rigid soled shoe is often the standard treatment protocol. If the lesser digital fracture is displaced, closed reduction many times can be carried out after the toe is put to sleep using a local anesthetic. Using distraction (pulling on the toe) the fracture many times can be reduced. Sometimes surgical reduction of lesser toe fractures is required utilising reduction and pinning of the toe. Fractures to the large toes (first toe, big toe) are much more serious. The big toe serves many functions including balance and with walking. There are two larger muscles that attach to the the big to via tendons. Because of these tendons, it is important for those people who have a big toe fracture to many times be placed in a below the knee walking cast or boot. Displaced (shifted) fractures of the big toe often have to be realigned using closed reduction (manipulation) or surgical reduction with pinning, screws and/or plates. It is very important to have a big toe injury treated by a qualified podiatric physician and surgeon.Sporting injuries to the big toe and lesser toes are also very common. This can include toe fractures, joint dislocations and and tendon ruptures. Prompt diagnosis and treatment is important for the quickest recovery and return to function. Traumatic toe injuries from machinery (warehouse, power equipment or farm injuries to the foot) are often very serious. Immediate medical attention is required to reduce the risk of toe and/or foot loss from damage to foot blood vessels and/or infection. One should seek immediate medical attention at a local emergency room or urgent care center. Blunt trauma to the big toe or lesser toes should also be evaluated in a timely fashion. Often times blood will collect under the toenail plate (subungual hematoma). This can cause prolonged pain and increase the risk to infection to toe. The skin under the toenail (nail bed) can be damaged from blunt trauma (injury) to the toe. If the nail bed is injured (lacerated) prompt repair is advised to reduce the risk of infection. Injury to the toenail plate and the nail bed often results in long term damage to the toenail not to mention toenail loss (toenail falling off) shortly after the injury. As the nail grows back, it is not uncommon for the toenial to be mishaped, thick and/or yellow. Toenail fungal infections are often acquired by trauma to the toenail and toes. Prompt diagnosis and treatment is of utmost importance for the best recovery.Dr. Eric Silvers is a board certified foot and ankle specialist practicing in McKinney, Texas and Prosper, Texas. His office phone number is 972-542-2155 and the office Website is www.advancedfoottexas.com. Same day appointments are often available. Dr. Silvers e-mail is drericsilvers@gmail.com

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Foot Doctor Discusses Bunions

Bunion Deformities

Bunions are caused by your big toe joints becoming incorrectly aligned. This causes the first joint on your big toe to slant outward and the second joint then angles toward your other toes. Your joints then begin to swell. It causes a bump of bone on the foot that can become very painful if left untreated. Bunions are hereditary in nature and often grow in size as years pass. Treatment options vary from padding and changing shoe wear to surgical procedures to straighten the toe and eliminate the bump. Most surgical procedures are performed on an outpatient basis at a surgery center or a hospital. Recovery from the surgical bunionectomy depends on the age of the patient and the type of procedure performed. Most patients are back into closed toed shoegear in 6 weeks. Dr. Eric Silvers practices at McKinney Foot and Ankle Center in McKinney, Texas and Advanced Foot and Ankle Center in Prosper, Texas. Visit our website at www.advancedfoottexas.com. Our office phone number is 972-542-2155. Same day appointments are available.

TAILOR'S BUNIONS

If you have a painful bump on the outside of your foot close to your 5th toe, you may have what we call a Tailor's bunion. It is very similar to regular bunion by your great toe joint but on the opposite side of the foot. It can become very painful with shoegear and pressure on the bone from other factors. If you have a tailor's bunion and it continues to worsen, you may develop a callus or even an ulcer at the site that eventually may become infected requiring more serious treatment. Tailor's bunions can be treated very easily by using accommodative padding techniques, orthoses, and even surgical treatment. Surgical treatment would involve removing the painful bony bump or performing a bone cut to shift the bone inward and thus decreasing the prominence of the bone. It can be performed on an outpatient basis. If you have this deformity and it is painful, please come see us.Dr. Kory Williams with Advanced Foot and Ankle is a surgically trained foot and ankle specialist. He practices with Dr. Eric Silvers and have locations in McKinney and Prosper, Texas. They can be reached at 972-542-2155 or by visiting thier website at http://www.advancedfoottexas.com/

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

Aging Feet

AGING OF THE FEETOver time, normal changes to the feet can occur. The feet are under a tremendous amount of pressure during daily activity. While walking, each step puts two to three times as much force as the person’s body weight.This pressure can alter the structure of the foot as the person ages. Feet can become slightly longer and wider. Some women experience such changes during pregnancy due to the added pressure of pregnancy-related weight gain and also due to their hormones causing increased body flexibility including the foot.There might be a slight flattening of the arch of the foot. This is normal as long as it is neither excessive nor causes pain. The foot and ankle may lose some flexibility with age as does many joints and muscles in the body. The pad of fat at the bottom of the heel may become thinner with age. Though these changes are unlikely to cause serious problems, they may be accompanied with a loss of balance.Any foot changes that cause pain or deformities should be checked by a McKinney, Texas podiatric physician. Thickening of the skin such as corns or bony growths like bunions are not part of normal aging. Changes in the shape or alignment of the toes could be signs of problems with the muscles of the foot. A McKinney, Texas podiatric physician can diagnose the condition and recommend appropriate treatment.Pain is not part of normal foot changes. Pain can indicate a problem with the nerves, such as Morton’s neuromas. It could also be due to fasciitis or other painful foot problems. Discolorations of the feet should not occur. Discoloration could be a sign of a circulation problem.Arthritis is a common problem among older adults. Arthritis can cause problems with the feet. Arthritis in the feet can cause pain, swelling, and stiffness. Though there is no cure for arthritis, medical treatment can limit its damage and debilitating effects. A McKinney, Texas Foot and Ankle Specialist should be consulted for any foot problems that are not part of normal aging.Dr. Kory Williams is a foot and ankle specialist trained to treat all foot and ankle problems including thoses associated with aging. He practices with Dr. Eric Silvers in both McKinney, Texas and Prosper, Texas. You may contact our office at 972-542-2155. Advanced Foot and Ankle Center in Prosper, Texas and McKinney Foot and Ankle Center in McKinney, Texas offer comprehensive treatment for all foot and ankle problems. You may visit our website at www.advancedfoottexas.com for more information about our practice.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155

McKinney Foot Doctor Discussed Foot Stress Fractures

Fractures of the foot can be quite common, but also quite serious. There are 28 bones in each foot and considering that our feet area used day in and day out to transport us, they do get a beating. Trauma such at a fall, twist or car accident can result in an occult fracture to the foot or the ankle. These types of fractures are easily diagnosed with x-rays and can be seen immediately after the injury. Treatment for occult fractures is with rest, ice, immobilization, casting, splinting, walking boots, or in some cases with surgery. The severity of the fracture and the health of the patient will dictate the treatment.Stress fractures are not as easy to diagnose and can be a frustrating foot and/or ankle problem to treat for both the physician and the patient. There are several causes of stress fractures. The most common cause is overuse of the foot. A stress fracture can be caused by a strenuous walk, jog, run or activity. Often the onset is gradual as are the physical finding of pain, swelling, redness, fever to the foot and sometimes bruising. Other causes of stress fractures can be systemic. Recurrent stress fractures of the foot, often involving the metatarsals (the long bones of the foot), can be a result of a systemic problem. Osteoporosis, softening of the bones, can lead to stress fractures of the foot or the ankle. Hyperparathyroidism (over activity of the parathyroid gland), tumors of the parathyroid gland, elevated homocysteine levels, Osteitis deformans or Pagets Disease (which is consistent with elevated alkaline phosphatase) all have been associated with recurrent foot stress fractures. Stress fractures can take 2-6 weeks before that are readily visible on x-rays. Sometimes MRI's are helpful in diagnosing stress fractures that are not seen initially on plain film x-rays. Treatment for stress fractures consists of casting, walking boots, rest, ice, elevation, compression, immobilization and sometimes surgery. If you feel that you may have a stress fracture in your foot, please call McKinney Foot and Ankle Center and we will be happy to treat you.Dr. Eric Silvers is a board certified foot and ankle specialist who practices in McKinney and Prosper, Texas. Dr. Kory Williams is a foot and ankle specialist who practices with Dr. Silvers at McKinney Foot and Ankle Center in McKinney, Texas and at Advanced Foot and Ankle Center in Prosper, Texas. Both offices serve the communities of Prosper, McKinney, Frisco, Anna, Allen, Plano, Little Elm, Melissa, Celina and Gunter, Texas.Dr. Silvers and Dr. Williams can be contact at 972-542-2155. Our office website is www.advancedfoottexas.com.

Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155