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April 19, 2015
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Children's soccer linked to ingrown toenails

Snug cleats, repeated kicking can contribute to a painful problem

Toes and feet can take a beating, especially from sports.

Foot and ankle surgeon Paul Marciano, DPM, says he treats many soccer-playing children for ingrown toenails.  He blames improper toenail trimming, snug soccer cleats and repetitive kicking for creating this painful problem.

“Many kids wear hand-me-down cleats that don’t fit,” says Dr. Marciano. “Older children like tighter cleats. They believe it gives them a better feel for the ball and the field.”

Dr. Marciano has offices in Southlake, Hurst, Keller, and Flower Mound and is a member of the American College of Foot and Ankle Surgeons. He says there are steps soccer moms and dads can take to prevent their children from suffering a painful ingrown toenail. First, teach children how to trim their toenails properly. Trim toenails in a fairly straight line, and don’t cut them too short. Second, make sure cleats fit properly.

“A child’s shoe size can change within a single soccer season,” Dr. Marciano reminds parents.

If a child develops a painful ingrown toenail, soaking their foot in room-temperature water and gently massaging the side of the nail fold can reduce the inflammation. But Marciano warns parents against home treatments, which can be dangerous. The American College of Foot and Ankle Surgeons lists myths about ingrown toenail home treatments on its Web site,

“If your son’s or daughter’s ingrown toenails show signs of infection, it’s definitely time to seek medical care,” says Dr. Marciano.

A foot and ankle surgeon like Marciano can remove a child’s ingrown toenail, and prevent it from returning, with a simple, 10-minute surgical procedure. During the short procedure, the doctor numbs the toe and removes the ingrown portion of the nail. Various techniques can permanently remove part of a nail’s root too, preventing it from growing back.

“Most children experience very little pain afterwards,” says Dr. Marciano, “and can resume normal activity the next day.”

For more information on ingrown toenails and other pediatric foot problems, contact Academy Foot and Ankle Specialists at 817-424-3668 or

April 12, 2015
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Power Mowers Pose Danger to Feet
Thousands of Foot Injuries Can be Prevented Each Year

Lawn care season is back and Academy Foot and Ankle cautions homeowners to protect their feet and the feet of those around them when using rotary-blade lawnmowers.

Each year, some 25,000 Americans sustain injuries from power mowers, according to reports issued by the U.S. Consumer Products Safety Commission. “The blades whirl at 3,000 revolutions per minute and produce three times the kinetic energy of a .357 handgun. Yet, each year we continue to see patients who have been hurt while operating a lawnmower barefoot,” said Dr. Suttle, a member of the American College of Foot and Ankle Surgeons.

Dr. Suttle said children under the age of 14 and adults over the age of 44 are more likely to be injured from mowers than others. She advises anyone who operates a power mower to take a few simple precautions:

  • Don’t mow a wet lawn. Losing control from slipping on rain-soaked grass is the leading cause of foot injuries caused by power mowers.
  • Wear heavy shoes or work boots when mowing – no sneakers or sandals.
  • Don’t allow small children to ride on the lap of an adult on a lawn tractor. Children can be severely injured by the blades when getting on or off the machine.
  • Mow across slopes, never go up or down.
  • Never pull a running mower backwards.
  • Keep children away from the lawn when mowing.
  • Keep the clip bag attached when operating a power mower to prevent projectile injuries.
  • Use a mower with a release mechanism on the handle that automatically shuts it off when the hands let go.

“If a mower accident occurs, immediate treatment is necessary to flush the wound thoroughly and apply antibiotics to prevent infection,” says Dr. Suttle. “Superficial wounds can be treated on an outpatient basis, but more serious injuries usually require surgical intervention to repair tendon damage, deep clean the wound and suture it. Tendons severed in lawnmower accidents generally can be surgically reattached unless toes have been amputated,” she adds.

Find information on this and other foot and ankle injury topics at, the consumer website of the American College of Foot and Ankle Surgeons.

Please call 817-424-3668 for an appointment for any foot and ankle injury!

April 12, 2015
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Alcohol sclerosing injections are a conservative therapy to treat neuritis and painful nerve conditions.  The most common use for these injections is neuromas.

A neuroma is an enlarged, benign growth of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue and/or bone rubbing against and irritating the nerves. Pressure from poorly fitting shoes or an abnormal bone structure can also lead to this condition. Symptoms may include sensations of thickness, burning, numbness, tingling, or pain in the ball of the foot.

Treatments generally include wearing corrective shoes or orthotics and/or receiving cortisone injections.  If cortisone injections fail, an alcohol sclerosing injection is another conservative therapy before surgical removal of the neuroma is considered.  In severe cases, however, surgical removal of the growth may be necessary.

Alcohol sclerosing injections, also known as chemical neurolysis, are made up of a dilute solution (4%) of ethyl alcohol.  They are given in weekly intervals until symptoms are resolved.  It can take anywhere from 3-7 injections for 100% relief to be obtained.  This procedure has fewer potential complications than surgical removal, and has a reported success rate up to 89%*.

(*Dockery GL:  The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections.  JFAS, 38(6):403-408, 1999.)

March 10, 2015
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What is Capsulitis of the Second Toe?

Ligaments surrounding the joint at the base of the second toe form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.

Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as predislocation syndrome—is a common condition that can occur at any age.

It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight-bearing pressure.

Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.

Because capsulitis of the second toe is a progressive disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages—the best time to seek treatment—the symptoms may include: 

  • Pain, particularly on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
  • Swelling in the area of pain, including the base of the toe
  • Difficulty wearing shoes
  • Pain when walking barefoot

In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. The unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe—resulting in “crossover toe,” the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during the earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury or overuse.

An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton’s neuroma, which is treated differently from capsulitis.     

In arriving at a diagnosis, the foot and ankle surgeon will examine the foot, press on it, and maneuver it to reproduce the symptoms. The surgeon will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.

Non-surgical Treatment
The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition. 

The foot and ankle surgeon may select one or more of the following options for early treatment of capsulitis:

  • Rest and ice. Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
  • Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
  • Stretching. Stretching exercises may be prescribed for patients who have tight calf muscles.
  • Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
  • Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

When is Surgery Needed?
Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The foot and ankle surgeon will select the procedure or combination of procedures best suited to the individual patient.

If you are having foot pain, or think you might have capsulitis, make an appointment today with one of our Foot and Ankle Specialists.



March 01, 2015
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March is National Women’s History Month

Academy Foot and Ankle Specialists would like to highlight Rosalind Franklin.

Who is Rosalind Franklin?  She certainly doesn’t have the most recognizable name…like Eleanor Roosevelt, Susan B Anthony, Anne Frank, or Mother Teresa.  You probably won’t find her on any lists of famous or influential women. 

In the 1950s, Franklin was instrumental in discovering the structure of the DNA double-helix molecule. The discovery of the structure of DNA was, without question, the single most important advance of modern biology.

Ms. Franklin worked intimately with 3 other scientists, Watson, Crick, and Wilkins.  Franklin was a skilled X-ray crystallographer.  She captured a X-ray photograph which was the basis for the understanding of the now well- known DNA alpha-helix structure.  The photograph was acquired through 100 hours of X-ray exposure from a machine Dr. Franklin herself refined.

Watson, Crick, and Wilkins shared the Nobel Prize for their work in 1962.  

Rosalind Franklin, however, died before her work could be rewarded, in 1958 of ovarian cancer, at age 37, perhaps from radiation exposure from her work. Unfortunately, she died without ever knowing the gravity and importance of her research.  She is the true definition of a pioneer!

The podiatry school in North Chicago is named for Rosalind Franklin and is where both Drs. Paul Marciano and Sara Suttle attended and obtained their Doctor of Podiatric Medicine degrees.





Dr. Paul Marciano On Ingrown Toenails 









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