Bone Spurs in the Big Toenail

If you notice a soft pink mass on the tip of your big toe or sensitive area under the nail plate that is protruding and is painful when pressure is applied you may have a subungal exostosis. A subungual exostosis is a benign bone growth that arises from the dorsal surface of the distal phalanx (a small bone at the end of the toe) and causes pain and deformity of the nail.

Common causes for subungual exostosis include trauma, narrow shoes, previous nail surgery and certain biomechanical deformities such as a Hallux limitus.

At Foot & Ankle Doctors, Inc. x-rays of the foot will be taken to examine the bony growth and its involvement of the big toe. Differential diagnosis include: osteochondroma, Nora’s lesion, and osteosarcoma.

Conservative treatment includes purchasing a wider shoe and continuing with routine podiatric care.

Surgical removal is the recommended course of action. There are various surgical approaches and incisions that can be used to remove the bony prominence depending on its severity. In most cases the big toenail is removed to gain access to the bony prominence, which is then cut out. A surgical shoe will be dispensed and should be worn for 1-2 weeks.

Dr. Dardashti

Puncture Wound

Stepping on a thumbtack, nail or piece of glass is something that shouldn’t be taken lightly. Most people try to treat themselves at home, however any object that penetrates the skin can lead to an infection especially if the object is not clean.

A puncture wound can lead to cellulitis, an infection caused by streptococcus or staphylococcus bacteria. Cellulitis will cause swelling and redness to the skin. The infected area will be warm and painful to the touch and you may develop a fever. If the bacteria enter the bloodstream the infection can spread to the rest of the body and sometimes lead to a life threatening infection know as necrotizing fasciitis.

If you step on a nail, seek medical attention immediately. If your tetanus shots are not up to date, your physician will administer a tetanus shot to protect you against lockjaw, an infection that can cause your muscles to painfully contract.

Treatment
Come see us at the Foot & Ankle Doctors, Inc
. within 24 hours after injury. We will remove the foreign object and take x-rays to ensure no pieces remain in the foot. We will clean the wound and monitor your progress during healing. In some cases antibiotics may be prescribed.

Complications
Infection is always a concern after a puncture wound. Signs of infection include warmth, redness, swelling, soreness and sometimes drainage. If the object penetrated to bone, a bone infection may occur. In some cases a painful scar or hard cyst may develop.

Dr. Farshid Nejad

Acute Compartment Syndrome in the Foot

Compartment syndrome is a painful condition that occurs from an increase in pressure within the muscles. Increase in pressure above normal levels can decrease blood supply to the muscles and nerves in that area which can result in permanent tissue damage.

Acute compartment syndrome is a medical emergency. It is usually caused by trauma such as a crush injury, a fracture or a constricting bandage or cast.

Chronic compartment syndrome is not a medical emergency. It is usually caused by repetitive physical activity such as running.

There are 9 compartments in the foot and each compartment has a fascia covering to keep the tissues in place. This fascia does not stretch easily and following an injury, swelling or bleeding can occur, resulting in increased pressure within the compartments. If the pressure is not released, permanent tissue damage can occur.

Symptoms – The 6 P’s of Compartment Syndrome

  • Pain out of proportion and not relieved by narcotics
  • Pulselessness
  • Parasthesia
  • Paralysis
  • Pallor
  • Poikilothermia

If you experience these symptoms, seek medical advice immediately

Diagnosis
A wicker catheter is a device that is used to measure compartment pressures. Normal compartment pressure in the foot is between 0-8mmHg. A compartment pressure measuring >30mmHg or 10-30mmHg below diastolic pressure is concerning and emergent fasciotomy may be needed.

Treatment
Depending on which foot compartments are affected incisions are made over the compartments to relive pressure. Fasciotomy incisions are left open 5 days to allow edema and swelling to dissipate. After the pressure has been adequately reduced the surgical sites are closed.

Acute compartment syndrome is a surgical emergency and if not treated immediately permanent damage and tissue death can occur. For more information on acute compartment syndrome come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Dardashti

Fracture Healing

All broken bones in the body undergo a natural healing process. Bone healing is a slow process and can take up to 8 weeks. Immobilization and compression is necessary for optimal bone healing.

There are four phases of bone healing

  • Inflammation: occurs within the first 48 hours. Swelling can help provide stability
  • Soft callus: occurs during the first two months. Fibrous tissue and cartilage tissue develop at the ends of the fracture site
  • Hard Callus: occurs during the 3rd and 4th month. The soft callus is replaced with bone and is visible on x-ray
  • Bone remodeling: Lasts for several months. The bone continues to return to its normal shape. Bone can regenerate back to 100% of its strength after a fracture

At Foot & Ankle Doctors, Inc we like to immobilize patients with fractures. Immobilization is an important part in promoting bone healing. Depending on the type of fracture a surgical shoe or boot may be used. In more severe cases surgery may be needed to fixate the fracture site with screws, plates or wires. A cast will be applied afterwards and physical therapy recommended once the bone is adequately healed.

Factors that Impair Bone Healing

  • Early weight bearing
  • Smoking
  • Fracture ends greater than 1cm apart
  • Poor nutrition
  • Certain medications

If bone healing is slow or delayed, our physicians can provide a variety of treatments to enhance bone growth such as bone stimulators, use of bone growth proteins and bone grafts.

Dr. Dardashti