SUBUNGUAL HEMATOMAS (RUNNER’S NAIL)

SUBUNGUAL HEMATOMAS (RUNNER’S NAIL)

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Subungual hematomas frequently occur in distance runners and I tend to see a lot of them in my practice. While it can be a controversial topic in regard to either draining or removing the entire nail, I learned early in my career that it is best to remove the entire nail.
Read one of my posts on Dr. Nicks Running Blog that gives a detailed approach on the benefits of removing a painful toenail to relieve the pressure from bleeding. 

Training errors and achilles pain – Dr. Nick’s Running Blog

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The following article, or blog post, is a great read for any runner who has been suffering Achilles tendinitis. I see this scenario played out over and over in my office. It’s training patterns that lead to the problem. Too many speed workouts. Running easy runs too hard. Running your long runs at race pace. […]

Source: Training errors and achilles pain – Dr. Nick’s Running Blog

Surgical removal of ingrown toenail. 

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Suffering from an infected ingrown toenail?

There are two possible solutions for your problem. If this is the first time you are experiencing an ingrown toenail, then a nail avulsion would be indicated. This is a surgical procedure performed in the office where the ingrown border of the nail plate is surgically excised. Antibiotics are typically not needed and the condition resolves by simply removing the ingrown nail border. The recovery period is usually 7-10 days and heavy activity such as running can be performed within 24-48 hours.

CAUTION:  THE FOLLOWING VIDEO CONTAINS REAL SURGICAL FOOTAGE

For recurrent cases of ingrown toenails, a permanent procedure is typically chosen. This involves the same technique as a nail avulsion, but a chemical is introduced into the nail groove and the nail matrix (cells that form the nail) is ablated to prevent the border of the nail from growing back.  The recovery period is slightly extended for this procedure as drainage usually occurs for 14 days. Regular activity, as well as exercise,  can again take place in 24-48 hours.

Questions?  Post in the comments section below!

 

Allergic reactions to drugs such as penicillin.

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Taking a new medication and you suddenly developed a rash?  It may be an allergic reaction to the medication.  This is not too common, but common enough that it presents to my office.

Here are several examples of the classic eruptions to the skin from a drug allergy.

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Dislocation of the second toe caused by a bunion deformity.

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Patients routinely present to the office with a painful second toe (especially on the bottom of the joint) not realizing the cause of the pain or deformity.  The toe is typically resting higher then the others and the patients complain that the toe is starting to “pop” up in the air.

Below is an example of a bunion correction and relocation of the 2nd toe that is 6 weeks post surgery.  She was back to work and in a regular shoe at this point functioning well with no pain.

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Reoccurring Bunion? It can still be fixed.

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Bunion surgery is sometimes a feared procedure which many times end up a with a great result and reduction in pain for the patient. Sometimes the deformity can reoccur which may require a secondary procedure. Here are some examples of what can be done to correct a bunion that has reoccured. Read More

Melanoma under the toenail?

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It is very common for patients to present with a discoloration of a toenail and are concerned about a melonoma. The above picture is an example of a patient who presented to me with discoloration to the right great toenail as a resulted of concern by the family doctor.

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What happens when you soak your foot in potassium chloride? 

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Nope, it’s not nail polish. This Is what happens when you soak your feet in potassium chloride. Well, a solution of it that is. This patient was attempting to use an old remedy to resolve a chronic foot pain by soaking his foot in a solution of potassium chloride and water. He temporarily stained his toenails as you can see.  Although the acid has left a black discoloration, it is only temporary and will grow out. 

How long does it take to recover from bunion surgery?

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Afraid of having your painful bunion fixed because you’ve heard the recover is very long? This is not always the case. The outcome varies depending on the severity of the bunion which also correlates with how long it has been present.

Procedure section typically will vary upon the severity of the deformity as well as a patient’s age.

Here’s an example of bunion surgery performed on a 55 year old female who had a mild/moderate bunion which required a simple procedure involving realigning the joint.  She was allowed to bear weight immediately post operatively and used crutches as needed. At three weeks progression moves from a surgical shoe/cam walker to a running shoe.  After 6-8 weeks patient will be allowed to begin exercising and more rigorous activity.

Painful Ankle? Look at what was inside of this ankle.

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Here’s a 65 year old male who presented with a chronic painful left ankle that he described as occasionally “giving out”.

Radiographs revealed an abnormally large fragment of bone (os trigonum) to the back of his ankle joint.
An MRI was performed as I was suspicious of a ruptured peroneal tendon. The MRI revealed no damage.

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Ingrown Toenails: Example of the infamous “hidden” nail.

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If you ever had an ingrown toenail that never responded to your “bathroom” surgery then you may want to read this to see why.

Typically when the nail plate irritates the surrounding nail fold, it breaks the king and gets covered by the inflamed nail fold.  When one tries to “cut the corner” out, they typically miss the entire side and cut a portion of the nail and apply pressure to pull it out.  A spike of nail is left behind and continues to grow and eventually is stuck into the nail fold which complicates the situation even further.  Now bacteria is enabled to enter the skin and an infection occurs.  When this occurs, the only way to remove the nail is through surgical excision and excising the entire side of the nail.

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Plantar Warts

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Plantars warts are caused by a virus that invades the skin on the bottom of the foot and creates thick callus like lesions that can be very painful.  They are more common in children and adolescents, but can occur in adults.  You can differentiate them from calluses by the interruption of skin tension lines and occasional appearance of tiny black dots which are small ruptured vessels as they are very vascular.

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The contracted or “curled” toe. Can I get rid of it?

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Hammertoes

It is very common to be born with or acquire a contracted or curled toe.  I see these routinely in the office and they’re really easy to fix as long as they’re still “flexible” in nature.  In other words, don’t wait until the deformity is so far advanced that the toes are “rigid” and no longer able to bend or straighten.

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Fracture Blisters: How this can indicate a broken bone.

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Fracture blisters occur when a bone is fracture which leads to swelling that has no where to go and eventually ends up accumulating in the skin forming a blister.  Sometimes when these blisters are seen after trauma, it is very likely to find a fracture on X-ray.

Here’s an example of a woman who had dropped a picture frame on her toe and ended up with a severely swollen toe and blister that formed 3 days later. The toe was found to be fractured after X-rays were taken.

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General Foot Pain? You May Have an Entrapped Nerve

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If you’ve ever heard of carpal tunnel syndrome, there is a very similar condition that exists in the foot and leg.  The condition is commonly referred to as tarsal tunnel syndrome.  Symptoms vary but typical are burning and numbness in the foot, heel, and toes.  Tingling and shooting sensations can also radiate up the leg to the knee. Read More

Bunion Surgery in 84 year old

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It’s never too late to fix your bunion.  Too often patients will present with a severe bunion deformity asking for possible options to reduce the pain so they can be more functional and do the activities they would like to do, but will not consider surgery.  Sometimes they think they are simply “just too old“.  This is not true.

If the patient a is healthy enough to undergo anesthesia and has no serious medical conditions that would put them at risk, then even patients who are in their 80s can have corrective surgery to fix their bunion.

Here are two examples of patients who were in their 80’s and had undergone what is known as a Keller procedure to fix their deformity.

The surgery is out-patient and takes roughly 45 in a hospital or surgery center and the patient can bear weight in the foot in a walking boot the same day.  The foot is kept in bandages which are changed weekly for 3 weeks.  During this period the patient will keep a surgical shoe or walking boot on. By 4-6 weeks an athletic or casual shoe Can be worn.

So how do you know if you need to fix your bunion? If it’s preventing you from doing the things in life you want to do and enjoy doing, then it’s certainly an option.

Leg and foot wounds can be difficult wounds to heal. 

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If you’ve ever known someone to have a leg ulcer that took months to heal, then you’ll appreciate how long and complex leg and foot wounds can be.  There are many health variables which play a role in why  some of these wounds take longer to heal which is specialized wound centers exist to care for these wounds. Our practice works at two wound centers in Ohio where we see unimaginable wounds of all complexities and we have an large array of resources to treat these wounds. Hyberic oxygen chambers exist to improve oxygenation of blood in patients who have bone infection or poor blood supply. Sometimes we implant skin grafts or new bioengineered tissue substitutes to close a wound quicker than it would take to heal naturally.

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Hallux Limitus

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Hallux limitus is the medical word for arthritis of the great toe which is the most common area to encounter arthritis in the foot.  Symptoms typically consist of lack of motion and pain to the joint with associated bony formation present to the top of the joint.  When you compare your great toe joints you may see the painful one not bending as far upward as the uninvolved joint.  There may also be grinding associated with this.

Treatment consists of flatter shoes to decrease the amount of motion to the joint, NSAIDS such as ibuprofen, cortisone injections, and surgical correction.   Surgical correction may consist of cleaning out the fragments and arthritis from the joint, inserting an implant, or fusing the joint.  Most of the times if this is caught early enough, cleaning out the joint or performing a cheilectomy will resolve the problem.

Flexor Tenotomy

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flexortenomy flexor tenotomy 2

Arthritis of The Great Toe

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One of the most common places for arthritis to occur in the foot is the big toe join. The condition can present in several different ways. A bunion deformity, which is a dislocation of the great toe joint resulting in a large bump in the inside of the foot, can lead to arthritic changes in the joint causing pain and grinding. Osteoarthritis of the great toe joint is the result of chronic grinding and eroding of the cartilage surfaces leading to “bone-on-bone” and eventually a large bump on the top of the toe joint.

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Treatment
When the deformity becomes painful there are several pathways that we follow to treat this. One is reducing the inflammation by either taking anti-inflammatories such as ibuprofen or naproxen, or cortisone injections into the joint. This can last anywhere from a few weeks to several years depending on the severity of the deformity.

Orthotics can be implemented to reduce motion but rarely are they effective at reducing pain.

Surgery is the most advantageous option in treating this condition and the procedure is dependent on the severity of the arthritis.  For mild cases, simply “cleaning out” the joint by removing fragments and remodeling the head of the metatarsal can provide relief. This will also stop the progression of the condition and prevent further joint damage which could cause more pain and irreversible damage.

Moderate cases can sometimes be treated by inserting an implant into the joint which can preserve the motion as well as reduce pain.  The implants have a good prognosis but do sometimes come with pain and swelling. Choosing the appropriate deformity for inserting the implant will offer the best outcome.

More severe cases will need to be fixed by fusing the great toe joint. Fusing the joint will prevent motion but had the best prognosis for stopping the pain.

Each option has its own recovery period ranging from 2 weeks to 6-8 weeks.

Evaluation and X-rays can be done the same day to provide the patient how severe their arthritis is.

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Welcome to The Foot Doc Blog

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Topical Nail Solution to soften and clear discolored toenails.
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