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February 08, 2015
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​Here are some basic foot care gudelines that everyone should follow!

  1. Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.
  2. Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.
  3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.
  4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.
  5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
  6. Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).
  7. Alternate shoes—don't wear the same pair of shoes every day.
  8. Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.
  9. Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.
  10. If you are a diabetic, please contact our office and schedule a check-up at least once a year.

Call for an appointment!  817-424-3668

December 07, 2014
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Not all pain in the big toe joint or a "bump" on the big toe joint is a Bunion.  It may be arthritis!  Arthritis of the big toe joint is Called Hallux Limitus or Hallux Rigidus.What Is Hallux Limitus/Rigidus?

Hallux Limitus or Hallux Rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe.  ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.  Hallux Limitus refers to the eraly forms of the arthritis and Hallux Rigidus refers to the later, more advanced stages of arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”


Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis – the kind that results from “wear and tear” – often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse – especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.


Early signs and symptoms include:

  • Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
  • Pain and stiffness aggravated by cold, damp weather
  • Difficulty with certain activities (running, squatting)
  • Swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including:

  • Pain, even during rest
  • Difficulty wearing shoes because bone spurs (overgrowths) develop
  • Dull pain in the hip, knee, or lower back due to changes in the way you walk
  • Limping (in severe cases)


The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

Non-Surgical Treatment

In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include

•   Shoe modifications.Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.

•   Orthotic devices.Custom orthotic devices may improve foot function.

•   Medications.Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

•   Injection therapy.Injections of corticosteroids may reduce inflammation and pain.

•   Physical therapy.Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

When Is Surgery Needed?

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

For more detailed information on Bunions, and to view our Photo Gallery of before and after pictures and X-rays, visit!!

November 30, 2014
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It’s that time of year again!  After last year’s blast of ice, this year BE PREPARED!!

‘Tis the season for icy weather.  And with icy weather, comes icy roads and sidewalks.  If you're not careful, it could be the season for an ankle fracture!  These types of fractures are very common when the conditions outside get slippery!

A broken ankle is also known as an ankle fracture.  This means that one or more of the bones that make up the ankle joint are broken.  Twisting or rotating the ankle, rolling the ankle, tripping or falling, or direct trauma, as in a car accident, can cause these fractures.

A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require surgery and that you not put weight on it for a few months.

Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.

According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.

There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician.

Symptoms of a broken ankle include:

  • Bruising.
  • Swelling.
  • Immediate and severe pain.
  • Inability to put any weight on the injured foot.
  • Tenderness to the touch.
  • Deformity, particularly if there is a dislocation or a fracture.

The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.

Contact one of the doctors at Academy Foot & Ankle Specialists for treatment! 

October 26, 2014
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Tarsal Coalitions Are a Cause of FlatFeet!

What is a Tarsal Coalition?

A tarsal coalition is an abnormal connection that develops between two bones in the back of your foot (the tarsal bones).  The tarsal bones are the talus, calcaneus, navicular, cuneiforms and the cuboid. 

These bones work together to provide the motion necessary for normal foot function.

This abnormal connection—which can be composed of bone, cartilage, or fibrous tissue—may lead to limited or a complete lack of motion and pain in one or both feet.  Pain may occur at the affected joint or at surrounding joints as well.

What Causes a Tarsal Coalition?

Tarsal coalition is a condition most often caused by a hereditary defect that occurs during fetal development and results in the individual bones not forming properly.  Less common causes of tarsal coalition include infection, arthritis, or previous trauma or injury in the area.

A tarsal coalition is difficult to identify until a child’s bones begin to mature.  Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle.  The findings of the exam will differ according to the severity and location of the coalition.

I addition to examining the foot, the surgeon will order x-rays.  Additional advanced imaging—such as CT or MRI scan—may also be needed to evaluate the coalition.

October 26, 2014
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What Is Posterior Tibial Tendon Dysfunction (PTTD) and What Causes It?

Posterior Tibial Tendon Dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot.  An important function of the of the posterior tibial tendon is to help support the arch.  But in PTTD, the tendon’s ability to perform that job is impaired, often resulting in a flattening of the foot (or collapse of the arch).  Overuse of the posterior tibial tendon is frequently the cause of PTTD.  The symptoms usually occur after activities involving the tendon, such as running, walking, hiking, or climbing the stairs.

The posterior tibial tendon starts as a muscle in the calf and becomes a fibrous cord that stretches down behind the inside of the ankle, and attaches to bones in the middle of the foot near the arch. This tendon helps hold the arch up and provides support when stepping off on your toes when walking. If it becomes inflamed, over-stretched or torn, it can cause pain from the inner ankle. Some patients also exhibit pain in the arch area where that tendon attaches.  Over time, it can lead to losses in the inner arch on the bottom of your foot and result in adult-acquired flatfoot.

PTTD is often called adult-acquired flatfoot because it is the most common type of flatfoot developed during adulthood.  Although this condition typically occurs in only one foot, some people may develop it in both feet.  PTTD is usually progressive, which means it will keep getting worse—especially if it isn’t treated early.

What are some Signs and Symptoms of PTTD?

•   Gradually developing pain on the outer side of the ankle or foot.

•   Loss of the arch and the development of a flatfoot.

•   Pain and swelling on the inside of the ankle.

•   Tenderness over the midfoot, especially when under stress during activity.

•   Weakness and an inability to stand on the toes.

Signs and symptoms of posterior tibial tendon dysfunction change as the condition progresses.

Early signs are pain on the inside of the foot and ankle (along the course of the tendon).  There may be pain, swelling, redness and warmth along the same area.  A flattening if the arch may also even be seen in the early stages.

As the condition progresses, the arch begins to flatten more.  There may still be pain on the inside of the foot and ankle.  At this point, the foot and toes begin to turn outward and the ankle turns inward.

As PTTD becomes more advanced, the arch flattens even more and pain often shifts to the outside of the foot, below the ankle.  The tendon has deteriorated considerably and arthritis often develops in the foot.  In more severe cases, arthritis may also develop in the ankle.

People who are diabetic, overweight, or hypertensive are particularly at risk.  X-rays, ultrasound, or MRI may be used to diagnose this condition.

Left untreated, posterior tibial tendon dysfunction may lead to flatfoot and arthritis in the hindfoot. Pain can increase and spread to the outer side of the ankle.

How is PTTD treated?

Because of the progressive nature of PTTD, it’s best to see your foot and ankle surgeon as soon as possible.  If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.

Left untreated, posterior tibial tendon dysfunction may lead to an extremely flatfoot and arthritis in the foot and ankle. Pain can increase and spread to the outer side of the ankle.  Pain from this condition may increase limitations on walking, running, or other activities.

Treatment for PTTD

Non-Surgical Treatment

•   Immobilization:  Sometimes a short-leg cast or walking boot is worn to immobilize the foot and ankle to allow the tendon to heal.  Some patients may even need to avoid all weight-bearing for a short period of time.

•   Weight Loss:  This can be an important factor in decreasing painful symptoms of PTTD.

•   Orthotic Devices:  To provide proper support, your foot and ankle surgeon may recommend an ankle brace or Custom Made Orthotics.

•   Physical Therapy:  Stretching exercises, icing, formal Physical Therapy by a Physical Therapist, supportive taping and bracing may be necessary as well.  Ultrasound is a common modality used to help rehabilitate the posterior tibial tendon.

•   Medications:  Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation.  NOTE:  Please consult your physician before taking any medications. 

Shoe Modifications:  The foot and ankle surgeon will advise you on footwear changes to make with your shoes and may provide special inserts designed to improve arch support.





Dr. Paul Marciano On Ingrown Toenails 









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