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Posts for: August, 2015

One of the most common diagnosis that we see in our practice is ingrown toenails. Children often hide this foot problem from their parents because of fear of going to the doctor. We consider the treatment for ingrown toenails to be virtually painless and we understand the anxiety that children as well as adults have before they come to see us. Let's talk a little about what an ingrown toenail is and how we treat this common foot condition.

An ingrown toenail occurs when the nail curves sideways into the skin alongside the nail. This can cause pain, especially when wearing tight shoes. It can also lead to an infection with redness and swelling. Ingrown toenails can be caused from trimming your own nails too closely, trauma to the nail, a family history of ingrown toenails, and sometimes pedicures.

The side of the nail will need to be removed in order to stop the pain and release any infection present. If there is a lot of redness and swelling, then an antibotic may also be used. The redness and pain should begin to go away within 48 hours. It will take about two weeks for the exposed nail bed to become dry and all the swelling to go down.

If only the side of the nail was removed it will begin to grow back in a few months. To prevent recurrence, that side of the nail bed may be treated with a strong chemical to prevent the nail from regrowing.

We utilized techniques such as topical freezing spray so that most of the time you do not feel the injection. We have had much experience over the years easing anxiety before the procedure. We are able to correct the ingrown toenail the day of the office visit and follow you closely to make sure the healing process goes well.

 

 


Pediatric Flatfeet and Sports

 

A flatfoot deformity is where the arch on the inside border of the foot is more flat than normal. Flatfoot deformities can occur in all age groups, but appear most commonly in children. Some of these children grow up into adults who have feet with normal arches, but many of these children have pain related to their flatfoot deformity throughout their lives. It is very important that if you have children with a flatfoot deformity that they are evaluated as soon as possible especially if your child is experiencing pain.

When the young child starts to first walk at about the age of 9-15 months of age, the foot has a fat or chubby appearance where there is a less bony architecture apparent in the foot. At this point in the development of the foot, it is very difficult to evaluate whether the child will have future problems with a flatfoot deformity.

At the ages of two and three, the child’s foot starts to show more of its characteristic shape since the foot is less fat and the bones are more prominent. If the child has a flatfoot deformity at the ages of two to three, then it is wise to have the foot examined by a foot specialist such as a podiatrist. The reason that it is important to have the feet examined at this age is because the young foot is still largely made of cartilage, with less bone than would be present in the adult foot. Since cartilage is relatively soft, the abnormal forces caused by a flatfoot deformity may cause permanent structural alterations to the bones and joints of the foot that will persist into adulthood.

Most cases of flatfoot deformity in children are also associated with excessive flexibility in the joints of the foot which is commonly caused by ligamentous laxity. Children with flatfoot deformity may have complaints in the foot such as arch, heel, or ankle pain which is generally associated with increased standing, walking, or running activities. However, since the excessive rolling inward of the arches of the foot also make the leg and knee more turned inwards.

Diagnosis

Pediatric flatfoot deformity can be diagnosed at a very early age, but is unlikely to be properly diagnosed unless the doctor is a foot specialist, like a podiatrist, and is familiar with the intricacies of the structure and biomechanics of the foot. After speaking with the parent and child, the our foot specialists will examine the foot both while the child is not bearing weight but also while the child is standing, walking or running. Often, the family history is also taken since the foot should be examined closely if the child has a close relative who had a painful flatfoot deformity as a child or adult.

During the examination of the child, the podiatrist is looking for abnormal structure or function of the foot and lower extremity, which could lead to either problems during childhood or adulthood. X-rays may be taken of the foot if a significant pathology is noted or suspected. The more severe the flatfoot deformity and the more significant the complaints in the foot or lower extremity, then the more likely the podiatrist will recommend specific treatment for the flatfoot deformity.

Treatment

If the child has a mild flatfoot deformity and no symptoms, then generally no treatment is recommended other than possibly yearly check-ups by the podiatrist. If, however, the child has a moderate to severe flatfoot deformity of has significant symptoms in the foot or lower extremity, then treatment is indicated.

Treatment generally starts with both supportive shoes, such as high tops, and some form of in-shoe insert such as arch padding for the milder cases of flatfoot deformity. More significant cases of flatfoot deformity may require more exacting control of the abnormal motion of the foot such as that offered by Custom foot orthotics. Custom foot orthotics limit the abnormal flat arch shape and rolling in of the heel bone during standing, walking and running activities which helps not only improve the appearance and function of the foot, but also greatly reduces the symptoms in the foot or lower extremities. Calf muscle stretching exercises are also commonly prescribed for children with tight calf muscles since the tight calf muscles can worsen the flatfoot deformity with time and make the child’s symptoms worse.

Very rarely is reconstructive flatfoot surgery recommended unless all other conservative treatment options have been exhausted. One minimally invasive surgery is called a SubtalarArthroereisis. It involves the placement of an implant in the space under the ankle joint (sinus tarsi) to prevent only the abnormal motion, but still allowing normal motion. This brief procedure only requires very little recovery time, and is completely reversible, if necessary.

Dr. Saffer was born with flatfeet and has been to foot specilalists his entire life. Dr. Saffer has been wearing custom foot orthotics since he was ten years old and was a competitive tennis and basketball player growing up. As an adult Dr. Saffer is able to participate in runnning and martial arts even with an excessive flattened arch.

For more information please refer to our website at www.carolinafootspecialists.net