Miami Dolphins Ronnie Brown Recovering from Lisfranc's Fracture

Miami Dolphins Ronnie Brown Ahead of Schedule on Rehab of Foot

Running back Ronnie Brown of the Miami Dolphins was having a career year last year when in one play against the Tampa Bay Buccaneers his season came crashing down with his football future in jeopardy. He suffered a Lisfranc’s fracture of his right foot which required surgery. Fortunately for him and the Dolphins, he is ahead of schedule and plans to take part in summer workouts and be ready for the upcoming season.

Lisfranc’s joint is a joint in the middle of the foot where the tarsal bones (midfoot) and metatarsal bones (long bones of the foot or forefoot) come together. Injury usually occurs when there is a traumatic impact or a violent rotational force where both the forefoot and midfoot come together, causing a ligament strain or complete dislocation of the joint or joints involved. This twisting force can also cause a fracture due to the ligamentous attachments. These injuries usually occur when players make a cut or shift in direction suddenly . It can also occur from a direct impact such as when a football player plants his foot to tackle an opposing player head on. While there are several different types of Lisfranc’s injuries ranging from sprains to dislocations to fractures, injuries to this area can have a lingering effect if not completely healed. Several athletes have suffered from Lisfrancs injuries including Larry Johnson of the Kansas City Chiefs, Dwight Freeney of the Indianapolis Colts and Kevin Jones of the Detroit Lions.

Lisfranc injuries are usually very painful and patients are usually unable to walk or bear weight on the affected foot. The imjury is also accompanied by swelling, bruising and diminished range of motion to the foot and toes. They are diagnosed initially by physical examination while taking into account the patient’s description of the injury, but a more accurate assessment is done by MRI, CT, Xray or all three.

Treatment consists primarily of restoring normal anatomy whether it be through cast immobilization or surgery. Following the surgery, physical therapy is done to strengthen the foot, reduce swelling and get the patient used to using the foot again. Once the injury is resolved, an orthotic is then used to support and maintain the anatomic alignment. These injuries can be serious and career threatening for elite athletes if they are not treated appropriately. If anatomic alignment is not properly restored, these injuries can become chronic and severely limit a patient’s ability to walk normally, let alone compete at a high level in professional sports.

If you suspect you have sustained a Lisfrancs injury, consult your local podiatrist for a thorough exam and treatment plan. Delaying or avoiding treatment can have serious detrimental effects on the function of your foot.

Lysacek Wins Gold Despite Stress Fracture of his Foot

Lysacek Wins Gold in Vancouver Despite Added Stress


This past week, U.S. figure skater Evan Lysacek skated to an Olympic figure skating gold medal, the first Olympic gold medal in over 20 years for a U.S. male figure skater. Aside from the usual physical and emotional stress associated with such an important event, Lysacek was also dealing with an entirely different kind of stress…a stress fracture of his foot. As you can imagine, any type of foot injury can be devastating to an ice skater, particularly on as severe as a fracture. However, despite the injury, Lysacek was able to work around it and skated to an almost flawless performance to capture the gold!

Stress fractures are small fractures that appear as tiny “cracks” and are sometimes difficult to detect on x-ray. They are most frequently caused by poor biomechanics or foot function, but can also be caused by repetitive trauma such as that sustained in a typical figure skating jump. Left untreated, they can progress into fully blown fractures which, in some cases, can require surgery to repair. In Lysacek’s case, he had been injured prior to the U.S. Championships and treated it conservatively with a walking boot and rest which allowed him to make a full recovery. In most cases, this is the only treatment that is necessary; however, it can be a difficult treatment to follow for athletes since they need to train, especially when preparing for the Olympics.

Once healed, he was able to perform at full strength and executed a quadruple jump, one of the most difficult jumps in figure skating which only a few competitors in the world are able to execute with precision. However, following the competition, he began to experience the same type of foot pain that had originally led him to wear the walking boot. Recognizing the signs of a stress fracture, he wisely opted not to do the quadruple jump in the Olympics to reduce stress to his foot. This created added pressure on him since it forced him into a position where every other element in his routine had to be flawless to make up for the reduction in the degree of difficulty of his program. This decision was later criticized by the silver medalist following the competition who bitterly complained that Lysacek did not deserve to win the gold because he did not attempt a quadruple jump. However, had he decided not to limit his performance, he may have been injured to the point where he would have had to withdraw from the Olympics and possibly risk jeopardizing the rest of his career.

Whether you are an Olympic athlete or just looking to stay fit through exercise, it is important to treat your foot pain as soon as it starts to prevent more serious injuries that can occur later if left untreated. In this case, it proved to be a smart move for Evan Lysacek as ignoring his foot injury could have cost him the gold, and more importantly, his career.

Ingrown Toenails - A Guide for the Bathroom Surgeon

As podiatrists, one of the most common conditions that we treat are ingrown toenails. Typically, patients will make an appointment after having tried to cut the nail out themselves or having tried products found in the local drug store. Others just tough it out until they or their loved one can’t stand the pain or site of it. Here is some useful information to consider if you suffer from this common condition.

Ingrown nails are typically due to an inherited condition that causes the edge of the nail to grow into the flesh of the toe which then causes pain, swelling and infection. While shoes and trauma can cause ingrown nails, most of the time they are hereditary and unavoidable. Left unattended, they can become extremely infected which can lead to loss of bone or amputation. Therefore, it is best to have them taken care of as soon as possible to avoid potentially disastrous complications.

Treatment of ingrown toenails can be as simple as cutting the leading edge of the nail on the side that hurts. Sometimes, this is enough to remove the painful nail spicule and can be done at home by the patient themselves. However, if the condition persists, a simple visit to a podiatrist will take care of the problem in just a few minutes. It consists of numbing the toe in the office, removing the offending nail border and using a chemical to ensure that the ingrown portion of the nail does not regrow. Following the procedure, patients can put their shoe on and walk out of the office. The only aftercare required is to wash the toe daily and apply antibiotic ointment and a bandaid. The toe usually heals within 10-14 days.

Occasionally ingrown nails can be caused by a small bone spur which develops on the bone under the nail bed and causes the nail to deform and become ingrown. In these cases, after confirming the bone spur on an x-ray, most podiatrists perform a procedure under local anesthesia where they make a small incision on the toe and file the bone spur down to relieve the pressure on the nail. At the same time, it may be necessary to do the procedure described previously as well to address the infection.

While many people take ingrown nails lightly, they can have serious consequences if left untreated. Just ask Yao Ming, the center for the Houston Rockets basketball team who had to have part of his big toe bone removed because of an infection from an ingrown nail which led him to miss several games at a crucial time during the season. In the case of diabetics, the consequences can be even more devastating as the infection can lead to amputation.

Therefore, perform bathroom surgery on your toes at your own risk and be aware of the consequences if your surgery is unsuccessful. If your ingrown nail persists, get a “second opinion” from your friendly local podiatrist who will be close by waiting to give you relief with a quick and easy solution

PinPointe Footlaser is Here! Say Goodbye to Fungal Toenails....

Onychomycosis describes a fungal infection of the toenails that causes them to appear thick, yellow and brittle which can lead to pain and infection. Over 6 million Americans suffer from toenail fungus and the incidence increases yearly. There seem to be a lot of misunderstandings about onychomycosis which I will try to clear up in this article.

Oral antifungals cause liver damage?
This can be true and false. Oral fungal medication does put your liver at an increased risk of damage, although when prescribed appropriately and carefully monitored, this is a rare occurrence and can be reversed by stopping the medication. For this reason, consuming alcohol is prohibited while taking the medication because it intensifies the risk of liver damage. To prevent any damage from occurring, doctors do blood work to determine the health of your liver before and during the course of your treatment.

You can NEVER have toenail fungus and athletes foot at the same time?
False. Toenail fungus and athlete's foot are caused by the same fungal organisms, thus it is very common to see both at the same time. Often, one will experience athlete's foot first and then the fungus migrates to the toenails. Therefore, when treating nail fungus, I commonly prescribe antifungal creams for the skin as well to make sure that all fungal organisms are eliminated. It is also recommended that all shoe gear be treated with antifungal spray as well to eliminate any fungal organisms that may be present there as well.

Sweaty feet can cause toenail fungus?
True! Fungus loves warm, dark, moist environments like your shoes. You're gym sneakers are a 5 star resort for the family fungi vacation. If you have sweaty feet, you are creating a haven in your shoes and socks for fungus to multiply. Podiatrists often prescribe treatments to reduce or eliminate excessive sweating of the feet to help eliminate fungal growth and odor. It is also recommended that people with sweaty feet use acrylic socks, not cotton, to absorb moisture and pass it on to the shoe. Cotton tends to absorb, but it stays on your foot like a wet towel, which encourages fungal growth. Allowing 24 hours between shoe use so that they can dry out also helps to reduce fungal growth.

Once I get rid of the fungus, it shouldn’t come back?
False. Fungus that grows under our toenails also grows in our shoes, showers, floors, soil, and almost everywhere we walk. Thus, reoccurrence after eliminating an infection can be very common. It is important to take preventative measures to keep fungus out of your toenails! There are a number of products that kill fungus in your shoes and on your feet. Using these products weekly after your toenail fungus is gone can help decrease the risk of seeing those ugly toenails.

Oral treatment is the only way to get rid of toenail fungus?
False. If the entire nail is infected, there are very few treatment options and oral medications tend to have the most documented success. However, there have been some recent developments which are gaining popularity quickly. There are several types of lasers that are proving to be quite effective in eliminating nail fungus. There is also a product called Keryflex that not only improves the appearance of the nails in as little as 15 minutes, but has also been shown to cure the nail as well. It is a topical resin that is applied by your podiatrist over your existing nail which essentially creates a new healthy looking nail. It requires 4-5 treatments every 6-8 weeks and is painless and about a tenth of the cost of most laser treatments.

Hopefully by now you realize that there are a lot of treatment options out there for nail fungus that are simple and effective. As with most medical issues, the earlier it is treated the easier and more effective the treatments. Run, don’t walk to your nearest podiatrist if you see any signs of nail fungus so that you can enjoy healthy, happy feet!!

Call our office at 281.313.0090 to make an appointment.
The laser procedure takes anywhere between 30 to 45 minutes.

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Beware... Children's Flat Foot Doesn't Always Go Away

Parents are usually concerned when they notice that their child’s feet are flat. Often, they take them to the doctor only to be told that their child will outgrow the deformity, which is often the case; however, in the instances when they don’t, they become more susceptible later in life to heel pain, arthritis and tendonitis. Treated early and aggressively, these conditions can be avoided in most cases.

Flat feet are also referred to as pes planus, pes planovalgus or pronation syndrome. It is commonly described as a foot without an arch. There are two types of flat foot: flexible and rigid. In a rigid flat foot, the arch appears flat when the child is sitting and standing. In a flexible flatfoot, the arch appears normal while the child is sitting but it collapses when the child bears any weight on the foot. The flexible form is less severe, more common and easier to treat.
 Flat foot is a normal part of the developmental process in children under three years old. Young children are very flexible and will appear to have a foot that is rolled in and pointing outward. However, after the age of three, you should see a podiatrist if your child’s foot still appears flat, particularly as they near kindergarten age.

The podiatrist will evaluate the entire lower extremity from hip to toe to determine if the child is experiencing any weakness or pain and to pinpoint the exact level where the deformity begins. Symptoms of flat foot can include pain in the foot, ankle or knee. The child may have a history of clumsiness, ask to be carried often or avoid physical activity. The doctor will take x-rays to evaluate the joints and alignment of the bones.

A tight calf is a common finding in all flatfoot patients, which can be a significant component to the patient's present and future pain since it causes the foot to compensate and function out of alignment. Therefore, it is common for children to undergo physical therapy to learn stretches and exercises that target the calf muscles to allow for more normal biomechanics or foot function.
 The gold standard for treating pediatric flat foot is orthotic therapy. Orthotics are custom made shoe inserts that restore proper biomechanics by correctly aligning the joints, ligaments and tendons of the foot. Since orthotics are custom made, they are designed to address each child's specific foot structure and associated problems. Although they do not restore proper position of the foot, these devices maintain the correct position of the foot to help prevent the flat foot from progressing and decrease the current pain that the child is experiencing while in use.

In rare cases, a child will continue to experience pain or disabling fatigue after all conservative treatments have been attempted. In these cases, surgery becomes the treatment of last resort. One of the most common procedures for pediatric flat foot is known as the subtalar arthroeresis or “implantable orthotic”, an implant that is placed in the rear part of the foot. The procedure takes only seven minutes and is done through a tiny incision. The implant creates an immediate arch allowing the patient to bear weight immediately and rarely needs to be removed. This procedure is done in children with severe pain in the arch or where the arch is so collapsed that it will lead to an arthritic condition when they get older.

Many parents worry about their children's flat feet, but in most cases children grow out of it by the time they reach kindergarten. However, if you suspect your child has a severe case or does not appear to be outgrowing their flat foot, it is always best to see a podiatrist as soon as possible, preferably before age three, to evaluate and treat them if necessary. After age three flat foot treatment becomes less effective and more complicated.

Heel Pain…Not Just for Grown Ups

Although heel pain is commonly seen in athletes or older adults, it is certainly not isolated to that segment of the population. In fact, heel pain is quite common in children as well, especially in those that are active. Of all of the causes of pediatric heel pain, Sever's disease, or calcaneal apophysitis, is the most common cause of childhood heel pain and usually affects children 8-14 years of age.


Sever’s disease is usually seen in kids that are active and affects males and females alike. Typically, patients experience severe pain in the back of the heel at the insertion of the Achilles tendon on to the calcaneus that significantly limits their ability to play sports and sometimes even to walk. Sever's disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate which lies between the Achilles tendon insertion and the main body of the calcaneus. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus or heel bone has two separate areas of ossification that are connected by a cartilaginous growth plate. As the calf muscle develops, the Achilles tendon becomes tighter, causing tension on the growth plate as the patient places the heel on the ground while walking. This trauma is magnified 2-3 times more during vigorous activity such as running or jumping. This then leads to inflammation and pain in the back part of the heel. Over time, simple activities such as running, jumping or even standing can cause severe heel pain. However, with the proper treatment, this condition is easy to resolve.
Treatment usually consists of rest, ice, elevation and a reduction in activity along with biomechanical correction. While it is difficult to keep active children away from their activities, offering them alternatives in a low impact form may help keep them on track during the recovery process. Activities such as swimming, biking, elliptical and roller-skating reduce the tension on the Achilles tendon since they limit the amount of stress placed on the growth plate. Stretching and physical therapy are also extremely important to create length in the Achilles tendon and reduce tension and swelling on the growth plate. Static stretching exercises along with Thera-band exercises and night splints are great ways to lengthen the Achilles tendon while electrical stimulation, ice massage and topical analgesics help with pain and swelling. More extreme cases may require immobilization and possibly Achilles tendon lengthening, although these cases are rare. Finally, orthotics play a significant role in pain reduction by addressing inefficient biomechanics and adding a small heel lift to reduce tension by the Achilles tendon on the growth plate.
Since Sever's Disease can last up to 18 months, aggressive treatment is recommended as early as possible to reduce down time. If treated early enough, treatment usually lasts 6-8 weeks and patients are usually able to return to their activities at 100% capacity without limitations or recurrence.
Dr. Marco A Vargas is a board certified podiatrist who specializes in foot and ankle surgery. His office is in Sugar Land, TX. For more information on general foot health, get a Free copy of his book, "Got Foot Pain?" by visiting his website: http://www.thefootpros.com

Matt Ryan Sidelined by Turf Toe

Matt Ryan Sidelined by Turf Toe

According to multiple sources, Matt Ryan will miss this week’s game due to a turf toe injury he sustained this past weekend while playing. Recently LaDainian Tomlinson suffered the same injury and Deion Sanders’ career was cut short because of it. While turf toe is a common injury, not a lot of people understand what it is or how it happens.
Turf toe is caused by a sudden, traumatic impact to the big toe joint or repetitive flexion of the toe while running or jumping where, in either case, the base of the toe jams against the bone directly behind it called the metatarsal. This causes the tissue that holds the big toe joint together, the joint capusule, to tear. As it tears, it causes swelling, pain and limited range of motion. It can also lead to instability of the joint causing excessive motion or laxity which in turn can cause a bony build up that can eventually limit or completely restrict motion at the joint. This condition is called hallux limitus or hallux rigidus respectively. It can also lead to arthritis in the joint. Pain from turf toe can be excruciating and can limit the ability to walk or play sports. People most prone to this are athletes such as tennis players or football players who repetitively and forcefully push off with great frequency. Playing on a hard surface, such as artificial turf, makes the joint more susceptible to this injury, hence the name turf toe.
Treatment usually consists of rest, anti-inflammatory, physical therapy, taping and the use of a functional orthotic designed to offload or remove pressure from the affected joint. Injections are sometimes necessary to reduce swelling and surgery is rarely done for this condition. Treatment can take 4-6 weeks followed by a gradual return to activity. For professional athletes such as Matt Ryan, this amount of time can mean the difference between making or missing the playoffs. However, returning too soon can cause re-injury and further delay a successful return.
Therefore, as is the case with most foot injuries, early detection and prevention are the key to minimizing down time due to turf toe. Choosing the appropriate footwear along with a good functional orthotic goes a long way to preventing reoccurrence of this injury.

Dr. Marco Antonio Vargas is a board certified podiatric foot and ankle surgeon specializing in sports medicine in Sugar Land, TX. Visit his website, www.thefootpros.com, where you will find foot health information, sports and general podiatry blogs, a copy of his FREE BOOK on foot pain and doctor-approved foot care products.