Toenail Trauma

An injury to your toenail is likely to be extremely painful. If this has happened to you, you should seek treatment immediately. But if you’re reading this for general informational purposes, we hope you’ll remember what to do if you ever suffer trauma to a nail. We at Integrity Foot and Ankle Associates in Lorain assist patients with all sorts of podiatric needs, and although toenail trauma is scary, it usually heals well if the proper protocol is followed.

The word “avulsion” is used to describe a nail that is wholly or partially torn off. If you suffer a nail avulsion, you should trim down the jagged edge so that it won’t catch on your sock or any other cloth you wrap it in on your way to treatment. However, you should not remove any other portion of the nail that remains. Even if your doctor has to remove the entire nail in a clinic, it can still provide protection from infectious microbes while you are in transit. Nails can usually regrow as long as the nail bed hasn’t been reshaped by scar tissue resulting from an infection or the injury itself. If the congealed blood underneath your remaining nail bed covers a small enough area, it may be able to be drained through a small puncture. If not, the injury beneath the nail bed may require stitches.

Often during treatment for nail bed trauma, an x-ray is taken of the patient’s foot to determine if their toe bones are fractured. If they are not, the toe would still need to be kept covered while the nail regrows, which could take as long as eighteen months. You will receive instructions from your doctor on caring for your toenail while it recovers, but you will need to avoid pinching it in tight shoes or socks and change the covering regularly. You will have to keep the bandages dry while you bathe, and use all of the antibiotics you are directed to use.

Doctors David J. Hintz and Michael A. Wenowitz run Integrity Foot & Ankle Associates at 1740 Cooper Foster Park Road #B, Lorain, Ohio, 44053. To schedule an appointment, visit Integrity Foot and Ankle or call 440-282-1221.

Tarsal Coalitions

Sometimes, a deformity that is present in a foot at birth won’t start causing problems until a child reaches adolescence. That is often the case with tarsal coalitions, a fairly common variant in foot structures that may contribute to fatigue and balance problems. Recently, we at Integrity Foot & Ankle Associates in Lorain described how to care for flat feet. We thought that this week we would discuss tarsal coalitions, since they are a common cause of fallen arches, and what can be done about them.

The tarsals are the group of bones at the back of the feet. They include the calcaneus, or heel bone, the talus, which connects to the leg bones, and the navicular, which connects to the bones leading to the midfoot. Tarsal coalitions usually form between the calcaneus and either the talus or the navicular, and a person who has one often has them in both feet. They usually form in utero as cartilage connections, but harden into bone when a person is between eight and sixteen years old. Less commonly, older people may develop tarsal coalitions due to arthritis or injuries. Since most people don’t get foot x-rays for no reason, tarsal coalitions often go undetected until they start causing problems after hardening.

Tarsal coalitions are not always painful, but the inflexibility they cause may result in balance problems on uneven surfaces. Consequently, people with tarsal coalitions are at elevated risk for rolling their ankles. They may also get sore from activities more quickly, or adapt unusual gaits. Shoe inserts can help redistribute the body’s weight comfortably, and steroidal injections may be appropriate in some cases for pain relief. But if dysfunction persists, a podiatrist may consider surgically removing the coalition and replacing it with muscle or fat tissue. Alternatively, if other joints have become overused as a result of compensating for the tarsal coalition, a podiatrist may consider fusing them, as well.

Doctors David J. Hintz and Michael A. Wenowitz run Integrity Foot & Ankle Associates at 1740 Cooper Foster Park Road #B, Lorain, Ohio, 44053. To schedule an appointment, visit Integrity Foot and Ankle or call 440-282-1221.

Osteochondral Lesion

A twisted ankle is a relatively common problem, and while it’s not fun, it’s usually treatable without major interventions. However, the patient’s situation may be more serious if there is damage to their cartilage. At Integrity Foot & Ankle Associates in Lorain, our podiatrists take particular interest in sports injuries. As such, they are experienced in treating osteochondral lesions in the foot. This means they can help patients to recover from cartilage breakdown in areas including the talar dome.

The talus is a bone in the ankle that the leg bones rest on top of. The top-side of the talus is covered with a dome of cartilage, which is a rubbery substance that provides cushioning. If a person has a degenerative condition or suffers an ankle injury, the cartilage may rupture, soften, or develop cysts. A breakdown in cartilage may be accompanied by a break in the bone, but not always. Since cartilage helps the joint to move freely, breakage in it could cause the bone to catch or click. The patient may also experience swelling and bouts of pain, particularly when putting the joint under pressure.

The ankle joints don’t always get a great deal of blood supply, and osteochondral lesions in the talus may be slow to heal. If a piece of cartilage breaks off and floats freely in the joint, it will continue to cause inflammation and obstruction. Identifying a talus dome injury is done through a combination of range of motion tests and imaging. The patient may be provided with oral or injected non-steroidal anti-inflammatory medication and be given a fitted ankle brace, with instructions on non-weight bearing exercises to do at home. But if the patient continues to experience pain or diminished function, we may determine that surgical removal of the damaged cartilage is necessary. In that case, surgery will usually be done through small holes, using miniature cameras, to allow the patient a faster recovery.

Doctors David J. Hintz and Michael A. Wenowitz run Integrity Foot & Ankle Associates at 1740 Cooper Foster Park Road #B, Lorain, Ohio, 44053. To schedule an appointment, visit Integrity Foot and Ankle or call 440-282-1221.