Texas Foot Doctor's Blog
Posts for: August, 2015
Introducing The Surgeons of Academy Foot and Ankle:
While you can read his professional bio on our website (http://www.texasfootdoctor.org/staff.html#dacus), here are some fun facts about our very own Dr. Dacus!
Meet Dr. Joel Dacus
•My hobbies are: flying amphibious aircraft and air camping
•If I could spend the day with one person (alive or passed) it would be (and why): I always wanted to meet Neil Armstrong the first man on the moon. Though I never got to meet Mr Armstrong, his courage, strong stable principles and his accomplishments were always an inspiration. I could easily spend a day with him talking all about his experience on the moon and his trip through space.
•I would like to meet: Felix Baumgartner the daring pioneer who jumped from a helium balloon at over 125,000 ft from near space.
•Some things about my family: I am happily married to the best woman on the planet! A true stable partner who gives me strength and purpose. We have three children- two boys and a girl of which we are so proud. All our children are accomplished and entering early adult life. One of our boys flys for the United States Navy.
•The most important thing to me: Jesus Christ, Wife and children and grand children
•My favorite pace I’ve traveled: Mt Kilimanjaro Kenya and Victoria Falls Zimbabwe
•My top bucket list item: Flying my plane across Australia to Tasmania with my wife
Make an appointment with Dr. Dacus today at our Keller location! 817-424-3668.
Soccer season: Prime time for foot, ankle injuries
Southlake, TX 76092 August 31, 2015 -- Soccer season is in full swing and a local foot and ankle surgeon strongly urges parents and coaches to think twice before coaxing young, injury-prone soccer players to “play through” foot and ankle pain.
“Skeletally immature kids, starting and stopping and moving side to side on cleats that are little more than moccasins with spikes – that’s a recipe for foot and ankle sprains and worse,” cautions Dr. Suttle, a member of the American College of Foot and Ankle Surgeons.
“Kids will play with lingering, nagging heel pain that, upon testing, turns out to be a stress fracture that neither they, their parents nor their coaches were aware of,” she said. “By playing with pain, they can’t give their team 100 percent and make their injuries worse, which prolongs their time out of soccer.”
Dr. Suttle said she has actually had to show parents x-rays of fractures before they’ll take their kids out of the game. “And stress fractures can be subtle – they don’t always show up on initial x-rays.”
Symptoms of stress fractures include pain during normal activity and when touching the area, and swelling without bruising. Treatment usually involves rest and sometimes casting. Some stress fractures heal poorly and often require surgery, such as a break in the elongated bone near the little toe, known as a Jones fracture.
“Soccer is a very popular sport in our community, but the constant running associated with it places excessive stress on a developing foot,” Dr. Suttle said. She added that pain from overuse usually stems from inflammation, such as around the growth plate of the heel bone, more so than a stress fracture. “Their growth plates are still open and bones are still growing and maturing – until they’re about 13 to 16. Rest and, in some cases, immobilization of the foot should relieve that inflammation,” Dr. Suttle said.
Other types of overuse injuries are Achilles tendonitis and plantar fasciitis (heel pain caused by inflammation of the tissue extending from the heel to the toes).
Quick, out-of-nowhere ankle sprains are also common to soccer. “Ankle sprains should be evaluated by a physician to assess the extent of the injury,” said Dr. Suttle. “If the ankle stays swollen for days and is painful to walk or even stand on, it could be a fracture."
Collisions between soccer players take their toll on toes. “When two feet are coming at the ball simultaneously, that ball turns into cement block and goes nowhere. The weakest point in that transaction is usually a foot, with broken toes the outcome,” he/she explained. “The toes swell up so much the player can’t get a shoe on, which is a good sign for young athletes and their parents: If they are having trouble just getting a shoe on, they shouldn’t play.”
For further information about various foot conditions, contact one of the doctors at Academy Foot and Ankle Specialists at (817-424-3668 or visit www.texasfootdoctor.org.
Thickened yellow toenails are most commonly a result of a condition called onychomycosis, or fungal toenails. Onychomycosis is most commonly caused by the fungus trichophyton rubrum, T. Rubrum for short, but can also be caused my several other types of fungus. The types of fungus that affect the skin and nails are called dermatophytes. Onychomycosis can also be caused by yeast caused candida as well as several types of molds.
Can Nails become thickened and yellow for reasons other than onychomycosis?
Nails can also become naturally thickened as we get older, and sometimes due to any trauma from running, playing sports, or just simply stubbing your toe. This trauma causes the nail to lift off its attachment underneath, the nail bed, which causes skin cells to start to accumulate underneath the nail bed. The nail bed is normally protected from “shedding” skin cells by the nail plate. This shedding of skin cells happens on the exposed skin of our body and is called keratinization. The skin under the nail does not keratinize in a healthy nail. However, when the nail lifts off the nail bed the nail bed can then start shedding its skin cells through keratinization, causing the nail to appear thick. In this instance, the thick nail is actually not a thick nail. The keratinizing skin underneath the detached nail is causing the nail to appear thick. This is why when you visit the doctors of Academy Foot and Ankle Specialists we will take a section of this nail to send to a pathologist and help us determine if the nail in fact has fungus in it.
So my nails are thickened by trauma or thickened by fungus?
Almost, but that doesn’t completely summarize it. If you’re interested, Dr. Bradley Bakotic, a podiatric dermatopathologist organizes nail unit dystrophy into four different types:
Type 1- Non-mycotic, non-keratinizing nail unit dystrophy
• Traumatic (matrical): median nail dystrophy
• Metabolic: Beau’s lines, diabetes mellitus/peripheral vascular disease
• Inflammatory: psoriatic pitting
• Genetic: some forms of ectodermal dysplasia
Type 2- Non-mycotic, hyperkeratotic nail unit dystrophy
• Trauma/microtrauma (nail bed): traumatic keratinizing nail unit dystrophy, onycholysis
• Metabolic: diabetes mellitus
• Inflammatory: psoriatic keratinizing nail unit dystrophy
Type 3- Primary mycotic nail unit dystrophy
• Keratinizing Dermatophytic (T. rubrum) Saprophytic (S. brevicaulis) Yeasts (rare Candida sp.)
• Non-keratinizing Dermatophytes (T. mentagrophytes) Saprophytic molds (rare Fusarium sp.) Yeasts (Candida sp.)
Type 4- Secondary mycotic nail unit dystrophy
• Any form of type 2 nail unit dystrophy complicated by dermatophytic or non-dermatophytic onychomycosis.
So what can Academy Foot & Ankle specialists offer me for treatment?
Now that we understand that there is more to thickened nails than a simple fungal infection we can discuss treatment. The first thing we will likely do to determine proper course of treatment is to take a small sample of your nail to send to a podiatric dermatopathologist who will then perform special tests on your nail and look at it under a microscope to help pinpoint what is responsible for this thick nail. We will then discuss options for treatment including topical, oral, and laser therapy. You should also eliminate any microtrauma by possibly changing shoegear and keeping nails trim. Unfortunately, there is not one simple cure-all for thickened fungal toenails, but working with the team at Academy Foot & Ankle Specialists we will fight this condition and find a solution together using the most scientifically advanced techniques available.
Come visit Academy Foot & Ankle Specialists at any of our four locations in Southlake, Flower Mound, Hurst, or Keller to for all your foot and ankle with our physicians Dr. Paul Marciano, Dr. Sara Suttle, Dr. Brady Mallory, Dr. Greg Amelung, Dr. Joel Dacus or Dr. Philip Parr.