Archive for February, 2010
Retrocalcaneal Bursitis – Heel Pain in Nacogdoches – Sowell Podiatry
Posted by: | CommentsI recently posted a foot pain discussion of Achilles tendonitis that I feel helps a patient suffering with pain on the back of the heel understand what might be going on. However, there is a diagnosis in the same anatomic area that often gets confused with Achilles tendonitis and I thought I should discuss it today. Retrocalcaneal bursitis refers to a fluid filled sac (bursa) that rests behind (retro) the heel bone (calcaneal). This bursa has the unenviable job of cushioning between the heel bone and the Achilles tendon. When this bursa becomes inflamed we call it bursitis.
As a podiatrist in Nacogdoches Texas, I see all types of patients with this painful condition but there is one type I seem to see more than others. This patient, I think, makes a good example for our discussion and should help us better understand the condition. I am speaking of the newly retired cowboy! Lol. This patient has worn cowboy boots for fifty years, usually with a pretty good heel on them, and has now retired from his work where the boots were required. So, he has begun wearing tennis shoes more and unknowingly began a mechanical condition that will lead to pain.
After years of wearing an elevated heel in a shoe, or boot, the tendon becomes adjusted to the length needed in that particular shoe. Over years it can become much shorter and if not stretched properly over those years it can have significant difficulty adjusting to its new environment in a tennis shoe. As the heel gets lower, the pressure between the tendon and heel bone increases and the bursa becomes irritated. I also see this in athletes who have been making their calf muscles bigger but not stretching them properly.
Treatment, after proper diagnosis, usually consists of ice, NSAIDS, physical therapy or steroid injections for the swelling and at some point will include a stretching program to lengthen the tendon. Heel pads and lifts have also been proven to help the situation. Of course, proper assessment is the key and is why I feel a podiatrist is necessary in all conditions concerning the heel.
Bluish-black Toenails – Podiatry in Nacogdoches Texas
Posted by: | CommentsBluish-black toenails are usually dry blood accumulations beneath the nail plates that result from long-term repetitive trauma. This condition is frequently seen in distance runners, exercise walkers, and in those individuals involved in racquet sports. The toes involved are most often the second digits (next to the big toe) because of their being the longest. In most cases, these toes are painless but generally cause concern because of their progressively darkening appearance.
The cause of this nail condition is repetitive trauma secondary to shoe pressure. What happens is that when a person stops in walking or running, the undersurface of the athletic shoe grips the ground and forward motion is abruptly halted. However, the foot inside the shoe often continues for a short time period to slide forward until the toes jam into the end and upper portion of the shoe. The result of this repetitive traumatic jamming pressure against the toes is predictably a thickening of the nail plate with frequent bluish-black discoloration due to the accumulation of blood.
There are no effective treatments for this problem as long as the involved activity is continued. I recommend to patients that they check carefully their athletic shoes for a proper fit, consider the use of Band-Aids during the activity for added protection, and make sure that their nails are trimmed properly. On rare occasion, when discomfort is present and continued athletic participation is in jeopardy, the involved nail plate(s) can be removed. However, after all is said and done, these discolored nails and athletic participation seem to go hand in hand and in most cases, with no serious consequences to the participant.
Fun Foot Facts from Mark E. Sowell, DPM
Posted by: | CommentsJust thought someone might find these foot facts interesting:)
Seventy-five percent of Americans will experience foot health problems of varying degrees of severity at one time or another in their lives.
The foot is an intricate structure containing 26 bones. Thirty-three joints, 107 ligaments, 19 muscles, and tendons hold the structure together and allow it to move in a variety of ways.
The 52 bones in your feet make up about one quarter of all bones in your body.
Plantar Warts – A Viral Blog by Mark E. Sowell, DPM
Posted by: | CommentsToday, we know that you don’t have be a liar, touch a toad, or drink a witch’s evil potion to get a wart. In all probability, you can’t even grow one by touching another person’s wart. Apparently, these lesions are non-contagious but can spread within the involved area of the same individual. In actuality, warts are encapsulated or walled off growths of viral tissue. Plantar warts on the feet are frequently painful with squeezing type pressure. In the vast majority of cases, the growth of a wart is preceded by some sort of skin puncture or would defect that in all probability, allows an entry site for contamination. Whether we all have inactive or potential wart viruses circulating in our bodies or gain the virus through the wound is as of yet unclear.
An interesting and often confusing distinction must be made between certain calluses and plantar warts. Skin lines or striations can be seen passing through callus tissue whereas they will pass around a wart. In addition, plantar warts, upon close examination, will often demonstrate small black dots which when trimmed will bleed. These are tiny blood vessels, which become caught in the growth itself and are absent in regular callus tissue. A final line of distinction in identifying a wart is in its response to pressure. Squeezing a wart will usually produce extreme pain as opposed to similar pain from direct pressure on calluses.
Warts that appear on the hands and fingers are usually more responsive to therapy than are those on the feet. The professional methods of treatment available for plantar warts include just about everything from chemical applications and surgery to Lawrey’s seasoned salt and hypnosis. Some warts respond quickly and some do not, and that my friends, is just plain honesty. I tend to start conservatively and if not successful become more aggressive in the fight. Even though we all know those old wives tales to be ridiculous, perhaps until your appointment with your foot specialist, you should stay away from toads, telling lies, and drinking weird tasting brews.
Abscess in the Foot
Posted by: | CommentsAs a podiatrist, I see many unusual things. Diabetics who have stepped on a sewing needle and not realized it, puncture wounds from thorns that went through a hunting boot and holes completely through a foot due to a misguided pressure washer! All of these injuries require the removal of a foreign body but they also have the potential to lead to an abscess. In fact, any break in the skin can lead to an abscess.
An Abscess is a collection of pus under the skin. Abscesses are considered localized infections that can cause pain and illness. An abscess can initiate the growth of aggressive infections to other parts of the body. When an abscess develops on the foot, the area involved may become red, hot, swollen, and tender. This infection can spread and ultimately affect other tissues in the foot and leg. When abscesses become large and go untreated, the infection can spread to the bone and lead to a bone infection (osteomyelitis). Once the bone becomes infected, more extensive surgery may be necessary to resolve the infection.
Abscesses can be caused by many factors. Patients that have depressed immune systems are much more at risk for developing an abscess. Diabetes is an example of a disease where one’s immune system is compromised. Often times, a small break in the skin or a blister can start the formation of an abscess. Poor hygiene can also contribute to abscess development and must be addressed during the course of any treatment. Abscesses can form on the feet and can be extremely painful. Abscesses tend to grow in warm moist places, and therefore, the foot is a frequent site for this condition. Trauma is another cause of abscess formation. When direct injury occurs to the foot or any part of the body resulting in a break in the skin, a pathway for infection is created.
Abscesses can be treated conservatively or surgically depending on the extent of the abscess formation. Initially, the treatment should consist of rest and staying off of the affected limb or body part. Warm soaks and moist heat can help alleviate the pain associated with abscess formation. Antibiotics are usually given to the patient to fight off the infection. However, depending upon the extent of the abscess and the organism involved, oral antibiotics may not be enough to fight off the infection. Drainage of the abscess may be warranted if the infection does not resolve. If the abscess is surgically treated IV or oral antibiotics may be administered. After the abscess heals or during the healing process itself, the wound should be kept clean and close monitoring of the condition should be performed.
As you can see, an abscess can be a very serious condition and should be evaluated and treated by a physician. Podiatrists are trained to handle injuries and infections of the foot and are an excellent choice when dealing with an abscess, or potential abscess.
Podiatrist with Blisters – Foot Pain in Nacogdoches
Posted by: | CommentsThree weeks ago my sixteen year old son and I set out to hike the four C’s trail here in East Texas. Basically it runs from the Neches river overlook to Ratcliff Lake Park near Crockett and spans about twenty miles. I was reminded of two things on this trip with my son…I’m not sixteen anymore…and blisters hurt!
Very few athletes that I know are unfamiliar with this term. For that matter, most of us at some time in our lives have formed that wondrous, yet ill-appreciated lesion called a blister. In general, blisters are raised and often fluid filled sacs of skin, which form in response to excessive heat and friction. In the earlier stage of formation, blisters will be reddened areas of irritation or hot spots. They will have definite burning sensations and will actually be warm to touch. In those cases of continued activity, a clear watery fluid will seep into the area and the outer covering of skin will separate leaving a true blister. New shoes, ill-fitted shoes, and just plain excessive walking can produce blisters in just abut anyone.
However, although blisters may seem simple enough, they can spell trouble. First of all, they can cause debility to such a point that a person cannot walk without pain. Secondly, blisters have somehow notoriously invited improper treatment often resulting in infection and further problems. Bathroom surgery without a license and with non-sterile instruments is indeed an open invitation to complications. The most effective approach in dealing with blisters lies in the concept of self-prevention. Checking one’s shoe fit, monitoring the activity level, and various types of shoe modification can be utilized to prevent these nasty hot spots from developing.
According to this author, the outer layer of the blister should be left in tact. It is a natural body defense shield against infection and greatly reduces the discomfort of the underlying raw tissue. In an office setting and with sterile instruments, the fluid is painlessly drained and an adequate lubricating type of medication applied to protect the blister. In about 24-48 hours the blister pain is gone and a layer of revitalized skin begins to form. It should be emphasized that blisters should not be ignored or treated carelessly. Although their occurrence and appearance seem quite simple, their potential hazards can indeed be complicated. Happy hiking!
