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Haglund’s Deformity

What is a Haglund’s Deformity?

Here in Frisco, Texas podiatrists see a variety of foot and ankle conditions.  One of the conditions we often see is called a Haglund’s deformity.  A Haglund’s deformity is a prominent bony enlargement located at the back of the heel at the area where the Achilles tendon attaches.  As the bony prominence enlarges, this can cause irritation to the Achilles tendon or bursitis (inflammation of a fluid filled sac between the tendon and the bone).

What causes a Haglund’s Deformity?

A Haglund’s Deformity is often referred to as a “pump bump” as it is commonly seen in females who wear pump like style high heels.  Haglund’s deformities are also seen more commonly in those with very tight Achilles tendons and in those with high arches.

What are the symptoms of a Haglund’s deformity?

  • Prominent bump located at the back of the heel
  • Pain at the site of the bump to touch and with certain shoe gear
  • Swelling at the site of the bump
  • Tightness in Achilles tendon

How to treat a Haglund’s deformity?

At Star Foot & Ankle Specialists, the podiatrists always start with conservative treatment options.  For a Haglund’s deformity the following are conservative treatment options:

  • Non-steroidal anti-inflammatory medications
  • Icing the affected area
  • Resting the affected foot
  • Stretching the Achilles tendon
  • Adding a heel lift to the shoe to alleviate pressure on the heel
  • Custom orthotics to help provide biomechanical control
  • Physical Therapy

If conservative treatment options fail, we then consider surgical treatment options which include shaving the prominent bone.

If you are in Frisco, Plano, or Little Elm and are experiencing pain in the back of your heel, please give us a call to schedule an appointment with Dr. Heredia or Dr. Zellers or click HERE.

Achilles Tendon Stretches

If you suffer from tight Achilles tendons or plantar fasciitis, stretching the Achilles tendon is super important.  Below are some exercises that can help prevent injury and reduce symptoms.

Wall Stretch

  1. Start by standing in front of a wall. Stand a couple of feet from the wall.
  2. Lean forwards toward the wall and place the palms of your hands on the wall.
  3. Take a step backwards with the leg you want to stretch. Keep this leg straight without any bed at the knee.  Make sure the heel is touching the ground
  4. Lean forward into the wall and bend the other leg.
  5. You should feel the stretch in the back of your calf on the straight leg. Adjust by moving closer or further to the wall if necessary until you feel the stretch.

 

 

 

Calf Stretch with Towel or Exercise Band

  1. Start in a seated position with the knee straight.
  2. Hook a towel or exercise band around your foot. Hold the towel or exercise band in each hand.
  3. Pull the towel or exercise band so that the ankle and foot stretch towards you.
  4. Hold this position for 30 seconds. Repeat 2 more times.
  5. Perform 3 times a day.

Stair Stretch

  1. Stand with the balls of both feet on the edge of a stair (or curb or step). Hold on to the railings or something sturdy nearby for balance.
  2. Keep your legs straight (a small bend in the knee is okay too if necessary), push up onto the toes, and then slowly lower your feet to let the heels hang down off the stair. You should feel stretching in the back of the calf and Achilles.
  3. Repeat this movement for 30 seconds. Repeat 2 more times.
  4. Perform 3 times a day.

 

 

Plantar fascia Stretch

  1. For this stretch you can use a tennis ball or a frozen water bottle. If you use a frozen water bottle, make sure to wear socks and not to apply directly to skin.
  2. Roll the tennis ball or frozen water bottle back and forth under the foot from the heel to the arch.
  3. Roll the tennis ball or frozen water bottle back and forth for 3-5 minutes.
  4. Perform 2-3 times a day.

If you are located near Frisco, Plano, or Little Elm and are suffering from tight Achilles tendons or plantar fasciitis, click HERE to schedule an appointment with Dr. Heredia or Dr. Zellers at Star Foot & Ankle Specialists.

Treating Achilles Tendinitis

 

What is Achilles tendinitis?

In Frisco, we have an active population and with that carries the risk of injury.  One of the more common injuries foot doctors see is Achilles tendinitis.  The Achilles tendon is the tendon in the back of the lower leg that connects the calf muscle to the heel bone.  This tendon is the strongest and largest tendon in our bodies.  This tendon is imperative to walking, jumping, and running.  When the tendon becomes inflamed, we start to develop Achilles tendinitis.  The tendon can become inflamed at the insertion on the heel bone or higher up in the lower leg.  When the tendon becomes inflamed at the insertion, there is sometimes a bony prominence called a Haglund’s deformity as well.  We will discuss this in a future blog.

Symptoms of Achilles tendinitis include:

  • Soreness in the back of the heel or lower leg
  • Swelling in the back of the ankle or lower leg
  • Pain that is worse with running, jumping, or pushing off from the affected foot
  • Some people may feel a “knot” in the Achilles tendon.

What are the causes of Achilles tendinitis?

Achilles tendinitis is often caused by overuse of the tendon.  This is commonly seen in athlete’s that quickly increase their level of exercise without proper training.  We often see Achilles tendinitis in weekend warriors, meaning those who may not be active regularly during the week but like to engage in more strenuous activities on the weekend.  Achilles tendinitis can also be caused by tightness in calf muscles and lack of proper stretching.  There are risk factors for Achilles tendinitis, including age and obesity.  Achilles tendinitis is also more commonly seen in men.

How do you treat Achilles tendinitis?

  • Stretches (which your local Frisco podiatrist can demonstrate and provide information on)
  • Orthotics/Custom Inserts
  • Non-steroidal anti-inflammatory medications
  • RICE protocol (rest, ice, compression, and elevation). This means taking time off from exercise.
  • Wearing supportive gym shoes with heel lifts
  • Physical therapy
  • Immobilization in a CAM walker boot if more severe
  • Surgical repair if conservative treatment measures fail

How do I prevent Achilles tendinitis?

  • Make sure to stretch before exercise
  • Alternate the types of exercise
  • Slowly increase the intensity and amount of exercise
  • Wear orthotics designed to alleviate strain on the Achilles tendon

 

 

If you are having pain at the area of your Achilles tendon in Frisco, Little Elm, or Plano click HERE to make an appointment with your local foot doctors, Dr. Heredia or Dr. Zellers, at Star Foot & Ankle Specialists.

Do I need orthotics?

What are orthotics?

Orthotics are inserts that are placed into a shoe to help alleviate foot, leg, and back pain.  Orthotics can be prefabricated or custom made.  Prefabricated orthotics are purchased over the counter often at sporting good stores, running stores, or even pharmacies.  Although they may be made for certain foot structures or to help alleviate pain for certain conditions, they are not customized to the patient’s foot.  Custom orthotics are available in the podiatrist’s office and are made from a scan or a cast mold to specifically fit a patient’s foot and address the patient’s symptoms.  Custom orthotics can be created with certain features to help relieve a patient’s symptoms.

Why would I need custom orthotics?

Orthotics may be needed for a variety of reasons.  For some, orthotics can offload areas of pressure or sores spots.  For others, orthotics can help correct any malalignment or control abnormal motion.

Here is a list of some conditions that orthotics can help treat:

  • Arthritis
  • Limb length discrepancy
  • Back/hip pain
  • Flat feet
  • High arched feet
  • Diabetic neuropathy
  • Bunions
  • Neuromas
  • Plantar fasciitis
  • Hammertoes
  • Chronic ankle sprains

 

What are they types of custom orthotics?

  • Functional orthotics: These are the most common type of orthotics that we make for patients. They tend to a be a little more rigid to provide more support and correction.
  • Dress orthotics: Not everyone can wear gym shoes all day. Dress/work shoes can be very fatiguing to the feet.  Dress inserts are made specifically to fit dress shoes (even heels) and provide comfort.
  • Accomodative orthotics: These orthotics are made of a softer material. They are typically made for people with diabetes or severe deformities/arthritis.  These orthotics are created to reduce pressure to the feet to help prevent ulcerations.
  • Sport orthotics: Orthotics can be made to help control motion and alignment in certain shoe gear such as cleats and golf shoes.

If you would like to know more or be casted for a pair of custom orthotics click HERE to make an appointment with our podiatrists at Star Foot & Ankle Specialists in Frisco.

Treating Ankle Sprains in Frisco

What occurs during an ankle sprain?

An ankle sprain occurs when the foot twists, typically pointing in an inward and downward position.  This can occur from a fall, during a sports injury, or even tripping on an uneven surface.  Ankle sprains can range in severity depending on the grade of the sprain.  More often we sprain the ligaments on the outside of our feet. To explain, ligaments are soft tissue bands, similar to rubber bands, that connect bones together.  The mildest sprain, grade I, occurs when the affected ligament(s) are stretched.  A grade II sprain occurs when the affected ligament(s) are partially torn.  The most severe, a grade III sprain, occurs when affected ligament(s) are completely torn.

 

What are the signs and symptoms of an ankle sprain?

  • Pain at ankle joint
  • Possible bruising
  • Instability when walking
  • Swelling

How do podiatrists treat and ankle sprain?

At Star Foot & Ankle Specialists in Frisco, we first will take xrays to make sure there are no fractures.  Then we start with conservative treatment including:

  • Icing affected area for 20 minutes (not directly on skin) 3-4 times a day
  • Compression with either an elastic bandage or ankle brace
  • Ankle brace for support
  • NSAIDs to help control inflammation and pain
  • Physical therapy
  • Rest (weight bearing will depend on severity of sprain)

If symptoms do not improve or resolve, we will consider ordering an MRI to assess for complete rupture of ligaments.  Sometimes when ligaments are completely torn or when a person has recurrent ankle sprains and instability, surgery is necessary to repair the ligament.

 

 

How to prevent an ankle sprain?

  • Stretching/exercising to avoid weak ankles
  • Avoid running on uneven surfaces
  • Wear supportive shoes, possibly even high top shoes
  • Use orthotics to help control the biomechanics of your feet
  • If you have a history of an ankle sprain, it is not uncommon to experience future ankle sprains. Once you have sustained a sprain, it is recommended that a patient use a brace with activity to prevent future ankle sprains.

If you have any concerns about ankle pain or instability or have a sprained ankle, click HERE or call 972-559-0051 to schedule an appointment with Dr. Heredia or Dr. Zellers

Treating Gout in Frisco

What is Gout?

Gout is an arthritic condition in which we have an excess amount of uric acid in our body.  When we have large amounts of uric acid, the uric acid can form crystals that deposit typically in joint spaces but can also occur in tendons.  When this occurs, the affected area may become very painful.

What causes Gout?

When we have an excessive amount of uric acid in our body this means either our body (kidney) is not getting rid of the uric acid efficiently or not breaking it down effectively.  Uric acid is a byproduct from the breakdown of purines.  Here are some reasons/contributing factors as to why we develop gout:

  • Hereditary
  • Some medications such as certain diuretics and low dose aspirin
  • Diet in heavy in food and beverages containing purines (alcohol, red meat, shellfish, organ meat)
  • Surgery

Of note, gout is more common in men.  People with high blood pressure, obesity, kidney disease, and diabetes may be more prone to developing gout.

What are the symptoms of Gout?

  • Severe pain usually localized to one joint (most commonly we see this in the great toe)
  • Redness
  • Swelling
  • Warmth at the affected joint
  • Often gout attacks begin when sleeping, and patient wakes up with severe pain. We often hear even bedsheets touching the foot cause pain.
  • If gout is chronic, there is a possibility for the development of a soft tissue mass. These are called tophi and are large deposits of crystals.

How to diagnose Gout?

Gout is typically suspected clinically when we have a patient that presents to the clinic with a red, hot, swollen foot that is in severe pain with no history of recent injury.  We may order a blood test to check your uric acid levels.  We will also take xrays to ensure no damage to the affected joint.  We may also attempt to draw fluid out from the joint using a needle to send to a lab for analysis.

How to treat a Gout attack?

  • NSAIDs, especially stronger ones such as indomethacin
  • Colchicine is another oral treatment option
  • Oral steroids can help ease symptoms
  • Depending on the severity, a cortisone injection into the joint is an option
  • Avoiding alcohol, red meat, shellfish
  • There are also medications that help reduce uric acid levels and prevent gout attacks
  • If a large tophi develops, there is a chance for the need for surgery.

How to prevent Gout?

  • Limit consumption of red meat, organ meats (liver for example), alcohol, and shellfish
  • If you have recurrent gout attacks speak with your primary or podiatrist for prevention medication
  • Stay hydrated

If you have symptoms consistent with gout or a history of gout and have concerns, please click HERE to schedule an appointment at Star Foot & Ankle Specialists.

Treating Hammertoes in Frisco

What are hammertoes?

A hammertoe refers to a deformity in the toe in which the toe starts to bend downwards.  The bend usually occurs at the level of the middle joint in the toes.  To explain the anatomy of a lesser toe, the toes have three bones called phalanges and a joint in between each phalange called an interphalangeal joint.  Hammertoe deformities are commonly seen in the smaller toes of the feet.

Hammertoes start flexible, meaning the toe can be manipulated and bent.  Over time, the hammertoe may progress and become rigid.  When the hammertoe is rigid, it is no longer able to move at the level of the joint and is “stuck” in that bent position.

What are symptoms of hammertoes?

  • Bend in the toes
  • Pain
  • Redness/possible sores on toes
  • Calluses/corns that develop from friction

What causes hammertoes?

Hammertoes are caused by an imbalance in the musculature of the toes usually secondary to your foot structure.  Hammertoes can be hereditary.  They can also be caused by trauma and arthritis.  Bunions can also lead to hammertoes by placing pressure on the second toe.  Wearing too tight or small of shoes can also contribute to the development of a hammertoe.

How do you prevent hammertoes?

  • Wear shoes with a wider toe box
  • Wear shoes with custom orthotics. These will help create support for your feet and can decrease the muscle imbalance causing the hammertoe.
  • Avoid high heels

How do you treat hammertoes?

We always start treatment conservatively.  This can include:

  • Changing shoes to more supportive shoes with a deeper toebox
  • Orthotics to support foot structure and decrease progression
  • Padding/strapping may be applied to reduce pressure and pain
  • NSAIDs for pain

If conservative treatment does not provide relief, surgical intervention is an option.  There are different surgical procedures depending on the severity and rigidity of the hammertoe.  Surgery is done in an outpatient setting.  Patient is typically able to walk in a surgical shoe or boot following surgery.

If you are concerned you may have hammertoes, the podiatrists at Star Foot & Ankle Specialists can help!  Click HERE to schedule an appointment.

Bunion Treatment in Frisco

What are bunions?

Bunions are bumps or prominences on the inside of the foot near the great toe joint.  Although we just think of a bunion as the bump on the side of the foot, there is more occurring than just that.  When a bunion develops, the big toe starts to angle or lean towards the second toe.  The large toe joint becomes out of alignment leading to the visible bump.  The medical term for this condition is Hallux Valgus.  Bunions start small and gradually progress with time.  Bunions are not always painful, however, the larger they become the more likely they are to become painful especially with wearing shoes.  Since the big toe drifts over towards the second toe, bunions (hallux valgus) can often lead to the development of hammertoes and calluses.

What are the symptoms of bunions?

  • Pain at big toe joint
  • Redness noted at the site of the bunion
  • Pain with snug shoes/ high heels
  • Numbness or burning pain as nerves can become entrapped between the bone and skin
  • Stiffness

What causes bunions?

Bunions are typically a result of a person’s foot structure, which is hereditary.  Although genetics are the cause of bunion (hallux valgus), certain risk factors such as wearing ill-fitting, unsupportive shoes may lead to progression and worsening of the deformity.  Bunion deformities are more common in women and over the age of 60.

 

What are treatment options for bunions?

Nonsurgical options will not fix the bunion but will alleviate symptoms and slow progression.  These include:

  • Orthotics to provide proper arch support and promote a better gait pattern. These will help slow down the progression of the bunion.
  • Supportive shoes with a wider toe box to accommodate the bunion
  • Bunion padding/shields/taping
  • NSAIDs for acute pain
  • Toe separators to take pressure off of the second toe
  • Cortisone injections are an option to alleviate acute pain and nerve irritation

If conservative treatment options fail, surgical intervention is the next step.  There are many different types of surgical procedures depending on the severity of the bunion.   Prior to surgery, we will need to take x-rays to help in surgical planning.  Often these surgeries, called bunionectomies, require cutting the bone and realigning it as well as shaving off any prominent bunion.  At Star Foot & Ankle Specialists, we also offer minimally invasive surgery.  Minimally invasive surgery results in minimal scarring and often leads to a quicker recovery.

If you are suffering from bunions click HERE to make an appointment to come see us and find the best treatment plan for you!

Fixing Flatfeet in Frisco, TX

Flatfeet is a condition of the foot where the arch appears to collapse.  In medical terminology, we refer to this as pes planus or as an overpronated foot type.  There are two main types of flatfeet: flexible and rigid.  Flexible flatfeet typically present in childhood and progress with age and can become rigid.  When a foot is described as a flexible flatfoot this means that the arch flattens when a person is standing and bearing weight but the curvature of the arch returns at rest.  When a flatfoot is described as rigid, this means the arch is collapsed with weight bearing and at rest.

Symptoms

  • Visible flattening/collapsing of the arch
  • Pain in the arches of the feet especially with extended walking or standing
  • Feet feeling overall tired/fatigued
  • Inability to walk or run long distances
  • Heel pain with extended weight bearing
  • Possible knee/hip/lower back pain
  • Possible development of other deformities such as hammertoes and bunions
  • Shin splints
  • Increased wear noted to the inside of your shoes

Causes/Risk Factors

  • Many children are born with flatfeet, but they outgrow this as the foot continues to develop. However, sometimes the flatfeet continue to progress due to foot structure.
  • Hereditary
  • Arthritis
  • Obesity
  • Tendon weakness/imbalance

Treatment

Nonsurgical:

We always start with nonsurgical treatment options whether child or adult.  Typically, symptoms can be managed and improved with conservative treatment.  This includes:

  • Orthotics (custom arch inserts) to provide support to your arches
  • Possible bracing if the ankle is affected
  • If weight plays a role then weight loss/diet modifications may be necessary
  • Recommend supportive shoes for your foot type
  • Physical therapy is sometimes necessary to help strengthen tendons/musculature
  • Possible medication for pain relief
  • Activity modifications

Surgical:

If conservative treatment fails for severe deformities, then surgical intervention may be necessary.  There are a variety of surgical techniques depending on the anatomy of your foot, age, and activity levels.   For adults this may involve surgery on the bones of the foot and possibly the tendons.  For children, we typically use an implant to raise the arch to avoid any bone work as children develop.

If you are having foot pain and think it may be due to flatfeet, click HERE to schedule your appointment at Star Foot and Ankle Specialists.

Ingrown Toenails in Frisco, Texas

Ingrown toenails are one of the most common conditions we see in our office at Star Foot and Ankle Specialists.  Ingrown toenails can be extremely painful and can lead to infection.  We most commonly see ingrown toenails on the big toes, but they can happen to the nails on the remaining toes as well.

Symptoms of an Ingrown Toenail

  • Pain near the toenail
  • Redness
  • Swelling
  • Drainage from the side of the nail that is ingrown. This drainage can be clear, bloody, or have pus.  There may also be an associated odor.

Causes of an Ingrown Toenail

  • Genetics
  • Trauma (dropping something that damages the toenail/repeatedly stubbing the toe)
  • Nails being trimmed incorrectly (digging into corners)
  • Too narrow of shoes causing pressure to the nails

Treatment of Ingrown Toenails

If you notice signs/symptoms of an ingrown toenail you can ease the symptoms at home by soaking the affected toenail in warm water and Epsom salts.  Please avoid attempting “bathroom surgery” and attempting to dig it out yourself.  This often will make the condition worse.  It is important to make an appointment as soon as you can with a podiatrist to treat the ingrown toenail so it does not become infected.  Although sometimes the nail can be trimmed at the tip to provide relief, most often the ingrown nail border will need to be removed.  This can be done the same day in office in a relatively quick procedure.  We start by cleaning and numbing the toe with local anesthesia.  Once the toe is numb, we use sterile instruments to remove the affected angry nail border.  We apply topical antibiotic ointment and bandage the toe following the procedure.  There is sometimes mild discomfort/aching to the toe for a few days following.  If the nail is infected, topical or oral antibiotics may be prescribed.

There is a possibility that the ingrowing toenail can return in the future.  We also present the option to permanently remove the ingrown toenail border.  This procedure is the same with the exception of the application of a chemical to destroy the nail root and prevent regrowth.  This procedure tends to cause discomfort for a little longer, usually about a week or so.

Prevention of Ingrown Toenails

  • When cutting nails, trim them straight across. Avoid digging into the corners.
  • Avoid cutting toenails too short.
  • Wear shoes that are not too narrow and cause pressure to the sides of the toes.

If you are experiencing any symptoms of an ingrown toenail, click HERE to schedule an appointment at Star Foot and Ankle Specialists!

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