Posts for: July, 2012

By Dr. Elizabeth Vulanich
July 26, 2012
Category: Uncategorized
Tags: Ingrown Nail   Fungus   Toenail Care  
Although there are numerous reasons for toe pain, one of the most common conditions seen in a Podiatrist’s office is an ingrown toenail.
What causes an ingrown toenail?
Causes for ingrown toenails are numerous, however common causes are improper cutting of the toenail or injury to the toe. One may also inherit the tendency for an ingrown toenail. In those cases it is due to inheriting a particular shape of toenail such as either a very broad, flattened toenail or a toenail with a very high arched shape. Certainly shoes which are poorly fitting and especially high heels with narrowed toe boxes also increase the likelihood of developing this problem. Toenail fungus may cause the toenail to become very thick or otherwise alter the nail shape predisposing to an ingrown toenail. Less commonly, some medications may change the shape of the toenails resulting in development of this condition.
An ingrown toenail may present initially as a toenail margin which is tender in shoes or with pressure. It may progress to an inflamed, red, warm, swollen, draining and infected toe which is exceedingly painful and interferes with the ability to wear a shoe. To best avoid this painful condition, it is recommended that toenails be cut straight across regardless of nail shape and to avoid improperly fitted shoes.
What should I do if I suspect it is an ingrown nail?
Early in the development of an ingrown toenail it may be helpful to soak in warm water several times a day. Applying topical antibiotic ointment and avoiding tight shoes may also be beneficial. Too often self- treatment, “digging out the toenail”, results in a worsened not improved condition. If you have tried conservative treatment without success it is time to visit with your podiatrist.
What will the doctor do?
Depending upon the stage of the ingrown toenail, your Podiatrist may simply cut out (avulse) a portion of the toenail. If the condition has been a frequent problem and/or if the toe is acutely inflamed, the toe may be anesthetized and the offending portion of toenail may be removed permanently such that the removed portion does not grow back. This is a little more involved procedure and includes destroying the portion of the nail root (matrix) which produces the painful portion of toenail. Home care typically involves daily soaks, antibiotic ointment, and bandage until the site has completely healed. Oral antibiotics are not regularly prescribed.
An untreated chronically ingrown toenail is not only painful but may actually encourage the development of fungus infection of the toenail. In worse cases, a chronic ingrown toenail may result in a severe infection involving the bone of the affected toe and ultimately require amputation.
To prevent and ingrown toenail, cut your toenails straight across but not too short. Wear properly fitting shoes, and protective shoe gear when indicated. Do not pick or tear your toenails! If you have toe pain that does not resolve despite your conservative attempts at treatment, it may be time to see a professional.

By Dr. Tarick Abdo
July 18, 2012
Category: Sports Injury

As school slowly approaches, fall sports have started their early season practices. Specifically, cross country, tennis, and football season will be upon us shortly. Unfortunately one of the most common ailments of the lower part of the leg is shin splints medically known as Medial Tibial Stress Syndome (MTSS). The symptoms of MTSS include shin pain over the inside lower half of the leg. Pain at the start of exercise which often eases as the session continues, but can return the next morning. Mild swelling of the inner aspect of the shin bone, tibia.

The most common cause of shin pain is inflammation of the sheath surrounding the tibia bone known as the periosteum. This results from traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation. Shin splints is a form of compartment syndrome where the muscles in either the medial, posterior, or anterior muscle groups in the lower leg swell due to increased activity. As may be seen in cross country, tennis, and football, athletes have not maintained fitness during the offseason and start engaging in high intensity activity. Thus these individuals may need to gradually increase activity and use rest, ice, compression, and elevation to reduce their symptoms.

More typically in my practice, biomechanical factors such as excessive pronation which strains the soleus muscle. This muscle has attachments along the inside of the shin bone. When an athlete excessively or rapidly pronates this places increased stretch on the soleus muscle resulting in pain and even microfractures of the shin bone. Other muscles implicated include the Posterior tibial muscle and the Anterior Tibial muscle. An experience podiatrist can aid in the proper muscle assessment.

In this case treatment is geared toward controlling the abnormal biomechanics, this is done with a custom foot orthosis. A custom foot orthosis requires a gait evaluation to gauge the degree of pronation and any compensation by the leg. In addition, a biomechanic evaluation is done with a custom mold or scan of the foot. Finally, a weightbearing foot x-ray which evaluates the position of the bones of the foot during the stance phase of gait. Furthermore, stretching to increase flexibility of the Achilles tendon helps alleviate symptoms.

Shin splints is a debilitating condition and can become chronic if not managed aggressively and diagnosed early. Thus athletes especially early in the season need to gradually increase their activity, where the proper shoes, and warm-up efficiently to prevent the onset of shin splints. If you unfortunately develop any of the aforementioned symptoms it is imperative that one rest and ice the area; however if symptoms persist, it is imperative that you consult a trained professional. Here at the Foot & Ankle Institute we can help get you back to activity quickly we are trained to evaluate this condition and manufacture a custom foot orthosis quickly so you can return to competition.

Good Luck this season to all the cross country runners, tennis players, and football teams in the Indianapolis Metropolitan area hopefully it will be a successful, injury-free season.

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