Enriched Plasma Protein - San Francisco Podiatrist Union Square CA

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Enriched Plasma Protein - San Francisco Podiatrist Union Square CA

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San Francisco Podiatrist Union Square CA - What Is Enriched Plasma Protein (PRP)?

Dr. Bill Metaxas discusses how enriched plasma protein can help promote faster healing for various foot and ankle conditions.

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Enriched Plasma Protein harnesses your body's own unique protein-based growth factors to mend tendon, ligament, bone and cartilage.

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Plantar Wart Treatment - San Francisco Podiatrist Union Square CA

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Plantar Wart Treatment - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the symptoms, causes and treatments for Plantar Warts.  

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PLANTAR WART (VERRUCA PLANTARIS)

 

What is a Plantar Wart?

A wart is a small growth on the skin that develops when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically they appear on the bottom (plantar side) of the foot. Plantar warts most commonly occur in children, adolescents, and the elderly.

There are two types of plantar warts:

• A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional "satellite" warts.
• Mosaic warts are a cluster of several small warts growing closely together in one area. Mosaic warts are more difficult to treat than solitary warts.

Signs and Symptoms

The signs and symptoms of a plantar wart may include:

• Thickened skin. Often a plantar wart resembles a callus because of its tough, thick tissue.
• Pain. A plantar wart usually hurts during walking and standing, and there is pain when the sides of the wart are squeezed.
• Tiny black dots. These often appear on the surface of the wart. The dots are actually dried blood contained in the infected capillaries (tiny blood vessels).

Plantar warts grow deep into the skin. Usually this growth occurs slowly-the wart starts off small and gets larger over time.

What Causes a Plantar Wart?

Plantar warts are caused by direct contact with the human papilloma virus (HPV). This is the same virus that causes warts on other areas of the body. Typically, the plantar wart virus is acquired in public places where people go barefoot, such as locker rooms, swimming pools, and karate classes. It can also be acquired at home if other family members have the virus.

Diagnosis and Treatment

To diagnose a plantar wart, the foot and ankle surgeon will examine the patient's foot and look for signs and symptoms of a wart.

The Foot and Ankle Institute offers numerous treatment modalities for the treatment of plantar warts. These include the typical treatment options of cutting-out the warts, freezing the warts, shaving the warts, using chemicals/acid on the warts, burning the warts and prescription medication to be applied by the patient.

The Weil Foot and Ankle Institute is one of the few practices in the country which offers 2 types of laser removal of warts along with radiofrequency ablation of the warts.

The CO 2 laser is used with local anesthetic and typically one treatment is needed to eradicate the warts. This is followed by daily soaking of the foot until the area is healed. The advantage of the CO 2 laser is that only one treatment is needed to remove the warts.

The pulsed-dye laser may be used with or without anesthesia and may include a series of treatments to eradicate the warts, however, it is less painful than the CO 2 laser or cutting out the warts. The biggest advantage of the pulsed-dye laser is that it allows the patient to return to full activity immediately.

The final treatment available is the Topaz by Arthrocare, which utilizes radiofrequency waves with local anesthesia to eradicate the warts. The advantage of the Topaz is that it is minimally invasive, with no need for soaking after the procedure. Usually the patient is able to return to full activity within a few days.

 

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Ingrown Toenail Treatment - San Francisco Podiatrist Union Square CA

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Ingrown Toenail Treatment  - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the symptoms, causes and treatments for Ingrown Toenails.  

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INGROWN TOENAIL

The nail, or nail plate, is made up of the same type of cells that makes up our skin, which is the largest organ of the human body. Like every other organ in the body, there can be problems. By far, the most common problem with human toenails are when they become embedded in the surrounding skin, or nail fold. This is known as an ingrown toenail.

The surrounding skin and nail plate become red, swollen, and painful. As this process continues there can be drainage, odor, and eventually an infection with pus. As the infection becomes more severe the pain may subside because the bacteria change the environment in which they are breeding, and can cause numbness to the local nerves. In the more advanced cases of ingrown toenail "proud flesh" will develop, and this is known medically as a granuloma. In the most severe neglected cases the ensuing infection can lead to cellulitis, and even an infection of the underlying bone.

Causes

The most common cause of ingrown toenail is improper cutting, trimming, or tearing of the toenail. Injury, genetic irregularity, severe curvature of the nail plate, sports, improperly fit shoes, improper pedicures, and occasionally chemotherapy can lead to deformity of the nail plate and result in an ingrown toenail.

Treatment

Since the most common cause of ingrown toenails is the improper cutting of the nail, it leads the patient to attempt self treatment, thus becoming what is known as a "bathroom surgeon". This is especially true in the case of adolescents and young adults.

If the cardinal signs of infection – pain/ redness/ swelling/ local heat/ drainage – persist for more than 2 – 3 days then you should consult with a Podiatric Physician. Simple debridement or trimming of the ingrown toenail may be all that is required to relieve your symptoms. In the more advanced cases, a local anesthetic will need to be administered in order to properly remove the offending portion of the ingrown toenail. If there is a severe infection involved, then oral antibiotics may be prescribed by your Podiatric Physician.

In cases where there are repeated episodes of a recurrent ingrown toenail then surgery may be recommended as a more permanent treatment.

Recommendations:

• Always cut your toenails straight across.
• Avoid cutting the toenails too short.
• Cutting a "V" notch in the center of the nail plate will not prevent ingrown toenails.
• Avoid shoe gear that is too short.
• Avoid using the over-the-counter ingrown toenail solutions which will NOT correct the underlying problem.
• Self treatment of a painful ingrown toenail is not recommended.
• Cut the nails, don't tear them.

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Union Square Podiatrist San Francisco, CA - Bill Metaxas, DPM

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Union Square Podiatrist San Francisco, CA - Bill Metaxas, DPM

Meet Podiatrist Dr. Bill Metaxas as he discusses foot care at The Foot and Ankle Institute of San Francisco

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The doctors and staff of The Foot and Ankle Institute of San Francisco are dedicated to using the latest research and advanced technology to deliver complete podiatric care to people of the San Francisco Bay Area and beyond.

Our doctors treat a variety of common and rare conditions of the foot and ankle, including heel pain, hammertoe, bunion, flat feet, plantar fasciitis, neuroma, wellness care of diabetic feet, including amputation prevention, sports medicine for casual and professional athletes, as well as advanced foot and ankle deformity planning and correction.

While providing exceptional care for the most common ailments like ingrown nails, fungus and ankle sprains, our doctors also take pride in pioneering new evidence-based treatment technologies.

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Sprain Ankle Treatment - San Francisco Podiatrist Union Square CA

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Sprain Ankle Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Sprain Ankle.  

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SPRAINS

Injuries to the outside of the ankle associated with rolling of the foot are known as ankle sprains.

The ankle ligaments provide stability to the ankle by helping to hold the ankle bone within the ankle joint. The ankle ligaments usually involved in an ankle sprain are also known as the lateral collateral ligaments of the ankle. The lateral collateral ligaments of the ankle are comprised of the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament.

The lateral ligaments provide stability to the ankle throughout the gait cycle as the foot bends up and down. Therefore total lateral stability of the ankle is provided by these three ligaments.

The most anterior (front) and most frequently injured of these ligaments is the anterior talofibular ligament. This ligament is intracapsular, or blended and contiguous with the lining of the anterior lateral aspect of the ankle capsule (joint). It can be seen as a fibrous thickening of the lining of the joint and courses from the front of the fibula to the front of the lateral surface of the talus.

The main function of the anterior talofibular ligament is the prevention of axial or rotational instability of the ankle. During gait as the heel is coming down, the foot is held in a dorsiflexed (up) position. Essentially the foot is pivoting on the edge of the heel only. Any irregularity in the ground, or laterally directed force, will cause the foot to twist in or out depending on the orientation of the force. Similarly, when we push off, the foot is in a plantar flexed (down) position. As the foot is plantar flexed, the position of the foot increases the long axis of the leg and increases the torque on the ankle region. Any ground irregularity or laterally directed force will cause the foot to twist in or out depending of the orientation of the force.

Classification of Injury

Rolling in of the foot (inversion), with the sole of the foot towards the opposite leg, is defined as a lateral ankle sprain. There are several classifications of this injury. A simple definition of injury breaks the injury down in terms of physiologic injury: sprain, strain or rupture which define the extent of stretching and A second classification of injury of the lateral collateral ligaments of the ankle is known as Grades 1, 2, or 3. This classification describes the functional loss of the ankle and the resultant grade or level of injury.

The end result of injury of one or more of the lateral collateral ligaments of the ankle is ankle instability. This instability can show up initially as a result of the severity of the injury or later as a result of chronic ankle instability.

During the moment of injury, due to the instability caused by the injury, movement and twisting of the Talus (ankle bone) in the ankle joint resulting in bone to bone compaction and twisting of other ligaments, tendons and nerves may occur. Injuries beyond the level of the ligaments themselves can occur and will occur depending of the level of injury. MRI, CT scans, bone scans and electro-diagnostic testing may be recommended to evaluate for these secondary injuries.

Chronic Ankle instability occurs much later than then original injury. Once the lateral collateral ankle ligaments are injured, they no longer provide the ability to stop ankle twisting and to hold the Talus within the ankle joint. As you walk or run with an unstable ankle, the talus can twist within the joint and partially come out of the joint. This movement is unnatural and abnormal and redirects force to the outside of the joint. With an increase in joint load to the outside, the foot will roll to the inside producing further tearing of the ligament and further injury.

Treatment

Conservative treatment for this condition depends on the necessity to stabilize the foot to restore the anatomical position of the ankle ligaments. The often noted RICE formula (rest, ice, compression elevation) is the standard initial treatment. Any treatment provided is to allow the ligaments to heal in the correct position and at the correct length. Depending on which ligaments are injured and to what degree the ligaments are injured, your doctor can provide you with the best ankle brace to stabilize your ankle.

Supplemental treatment for secondary injuries incurred at the time of injury will be diagnoses and treated at the same time as the treatment for the ankle ligaments.

Surgical Treatment

Surgical treatment of the ankle ligaments or associated injury conditions are performed when instability develops later or the injury is severe enough initially that stabilization must be done to allow for proper healing.

 

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Foot and Ankle Fracture Treatment - San Francisco Podiatrist Union Square CA

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Foot and Ankle Fracture Treatment - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Foot and Ankle Fracture.  

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FRACTURE REPAIR

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

What is a Fracture?

A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic Fractures

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact-like seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.

Signs and symptoms of a traumatic fracture include:

• You may hear a sound at the time of the break.
• "Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Deviation (misshapen or abnormal appearance) of the toe.
• Bruising and swelling the next day.
• It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended.

Stress Fractures

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated.

Symptoms of stress fractures include:

• Pain with or after normal activity
• Pain that goes away when resting and then returns when standing or during activity
• "Pinpoint pain" (pain at the site of the fracture) when touched
• Swelling, but no bruising

Is it a Fracture, or a Sprain?

Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.

Consequences of Improper Treatment

Some people say ,"the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

• A deformity in the bony architecture, which may limit the ability to move the foot or cause difficulty in fitting shoes.
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected.
• Chronic pain and long-term dysfunction.
• Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself.

Treatment of Metatarsal Fractures

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

 

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Diabetic Amputation Prevention - San Francisco Podiatrist Union Square CA

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Diabetic Amputation Prevention - San Francisco Podiatrist Union Square CA

Dr. Bill Metaxas discusses the Diabetic Complications and Amputation Prevention.  

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DIABETIC COMPLICATIONS AND AMPUTATION PREVENTION

People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. Furthermore, in diabetes, small foot problems can turn into serious complications.

You can do much to prevent amputation by taking two important steps:

• Follow the proactive measures discussed below
• See your foot and ankle surgeon regularly.

Your Proactive Measures

You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:

• Inspect your feet daily. Skin or nail problems-Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing). Signs of fracture-If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately. (If your eyesight is poor, have someone else do it for you.)
• Observe for changes in circulation. Pay attention to the color of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
• Don't ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
• Nail cutting. If you have any nail problems, hard nails, or reduced feeling in your feet, your toenails should be trimmed professionally.
• No bathroom surgery. Never trim calluses or corns yourself, and don't use over-the-counter medicated pads.
• Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
• Don't go barefoot. Wear shoes, indoors and outdoors.
• Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren't bunched up.
• Have your sense of feeling tested. Your foot and ankle surgeon will perform various tests to see if you've lost any feeling.

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Treatment for Ankle Arthritis - San Francisco Podiatrist Union Square CA

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Treatment for Ankle Arthritis - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments for Ankle Arthritis.  

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OSTEOARTHRITIS OF THE FOOT AND ANKLE

What is Osteoarthritis?

Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage-the connective tissue found at the end of the bones in the joints-protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one's ability to easily perform daily activities.

Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Many people refer to osteoarthritis simply as arthritis, even though there are more than 100 different types of arthritis.

Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle.

Signs and Symptoms

People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following:

• Pain and stiffness in the joint
• Swelling in or near the joint
• Difficulty walking or bending the joint
• Some patients with osteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over the surface of the bone spur. Bone spurs can also limit the movement of the joint.

Causes

Osteoarthritis is considered a "wear and tear" disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint.

An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is also often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain.

Sometimes osteoarthritis develops as a result of abnormal foot mechanics. People who have flat feet or high arches are at increased risk for developing osteoarthritis in the foot. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis.

Diagnosis

In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted.

In addition to the foot examination, x-rays may be ordered to help the doctor diagnose osteoarthritis and evaluate the extent of the disease in the foot and ankle.

Treatment: Non-Surgical Options

To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more non-surgical approaches.

When is Surgery Needed?

If non-surgical treatment fails to adequately reduce the pain associated with osteoarthritis, surgery may be recommended. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient's condition and lifestyle.

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Treatment for Bunions and Hammertoes - San Francisco Podiatrist Union Square CA

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Treatment for Bunions and Hammertoes - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments of Bunions and Hammertoes.  

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What Causes a Bunion?

A bunion is a prominence on the side of the foot by the big toe joint. The big toe may also be leaning over towards the smaller toes.You are usually born with the foot type that predisposes you to bunions. People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. Over time, the mechanics of your foot and shoe gear increases the deformity of the bunion. Woman are more frequently affected, probably because of the types of shoes they wear.

What Causes Hammer Toes and Claw Toes?

The most common toe deformities are hammer toes, claw toes, and bone spurs. These involve the lesser toes (2nd through 5th toes). In a hammer toe, the toe is bent at the middle knuckle of the toe, while in a claw toe the toe is bent at both the middle knuckle and tip of the toe. A bone spur can occur anywhere on the toes but most commonly affects the 4th and 5th toes. Each of the deformities can create corns on the toes and in more severe cases redness, swelling, and even an open sore can develop. It is important to note that the corns are not a skin problem! They develop because the skin is being crushed and irritated between the bones in your toes and your shoe.

You are usually born with the foot type that predisposes you to hammer and claw toes. People with flat feet, high-arched feet, or really flexible feet are more prone to develop these problems. Other causes are excessively long toes, tendon imbalance, injury, rheumatoid arthritis, and neuromuscular disease. Over time, the mechanics of your foot and shoe gear increases the deformities. Women are more frequently affected, probably because of the type of shoe they wear and the use of tight stockings.

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Bunion Surgery - San Francisco Podiatrist Union Square CA

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Bunion Surgery - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses the symptoms, causes and treatments of Bunions.

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BUNIONS

What Causes a Bunion?

A bunion is a prominence on the side of the foot by the big toe joint. The big toe may also be leaning over towards the smaller toes.You are usually born with the foot type that predisposes you to bunions. People with flat feet or really flexible feet are more prone to develop problems with bunions. Other causes are injury, rheumatoid arthritis and neurovascular disease. Over time, the mechanics of your foot and shoe gear increases the deformity of the bunion. Woman are more frequently affected, probably because of the types of shoes they wear.

What are the Symptoms?

The severity of the deformity may not correlate to the degree of pain. For example, a bunion that looks severe may have no pain; while a mild looking bunion may be incapacitating. Pain usually develops over the large prominence due to the friction of the shoe in that area. This rubbing of the shoe may cause a red, inflamed sac of tissue called bursitis. As time goes on pain may develop deep in this joint, limiting walking, exercise or even just standing comfortably. High heeled or pointed shoes will exacerbate these symptoms.

When the joint has been in a mal-aligned position for many years, osteoarthritis will develop. Arthritis causes increased stiffness and pain within the joint.

Bunions may also effect the adjacent smaller toes. When the big toes start to angle over, the big toe may cause increased pressure on the second toe or the second toe may be pushed upwards out of the way. This causes hammertoes and/or callouses on the lesser toes.

What are the Treatment Options?

When bunions are causing mild to moderate pain, the simplest solution to try is a wider, more accommodating shoe. This includes lower heels, softer leather, wider toe boxes and gym shoes. Cushions may provide relief from shoe pressure over the prominence. Anti-inflammatory medication may also provide relief.

When the bunion is painful despite the conservative therapy options or you cannot find shoes that are comfortable, surgical correction should be discussed with your podiatric physician. The longer surgery is delayed in a symptomatic foot, the greater the amount of arthritis that develops, and the more complicated the surgery becomes. Patients who have their symptomatic bunion corrected earlier tend to have greater satisfaction after the procedure.

What Does Surgery Involve?

The goal of surgical correction is to restore normal alignment and function of the great toe joint. The large bony prominence is removed and a cut is made in the bone to move it back into a normal position. Screws and/or pins may be used to hold the bone in proper position. If the joint is destroyed from arthritis beyond repair, it may need to be replaced with an artificial joint.

Following surgery, the foot is bandaged and a post operative shoe is worn for one week. Athletic shoes may be worn after the first week. Exercise and prolonged standing are restricted for the first 6-8 weeks. A home exercise program is important for regaining the strength and flexibility. You may steadily resume activities and wear more fashionable shoe gear as healing occurs.

 

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Custom Orthotics - San Francisco Podiatrist Union Square CA

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Custom Orthotics - San Francisco Podiatrist Union Square CA

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Dr. Bill Metaxas discusses how custom orthotics can help correct biomechanical problems of the foot to alleviate heel pain and other foot problems.

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Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotic are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure. Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

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