Alex Trebek Tore Achilles Tendon...What Next?

It has just been released that Alex Trebek tore his Achilles tendon while fighting off a burglar in his hotel. Wow! So now what? Alex should be expecting surgery to fix that torn Achilles tendon and a year long recovery.

In trauma situations, the Achilles tendon can be injured by sudden forceful movements of the foot against the leg. Or blunt trauma to the tendon area can cause the tendon to tear or rupture. When this occurs, the person often feels a sharp pop or pull on the back of the calf and often describes a feeling of being shot in the leg. Instant swelling and bruising occurs with an inability to really use that foot. Without the Achilles tendon the foot has a tendinacy to "flop" on the leg.

On exam, the back of the leg will be swollen and bruised. Pain is usually not as bad as you would expect, but is still present. And there will be a gap along the leg just above the heel where the tendon is torn. In the office we do a simple calf squeeze test to check the tendon integrity. If you squeeze the calf and the foot fully points, all is good, no full tendon tear (normally). But if you squeeze and the foot just stays the same...not so good, the tendon is no longer attached.

Now we need to fix it because leaving it torn will cause drop foot and the need for long term bracing to walk. Fixing the tendon requires surgery where the 2 ends of the tendon are sutured back together. A fiberglass cast is applied to protect the tendon and there is no walking on that foot for 4-6 weeks.

Long term, physical therapy is necessary to regain strength of the calf muscle and improve confidence in using that foot and leg. This process can take about a year before the patient returns to full unlimited activity.

Job well done, Alex, on fighting off the bad guys. We wish you a speedy recovery!

A Cut on the Foot Leads to Hospital Stay

Summertime is great in Texas. We have clear skies, very hot weather and plenty of lakes to cool off in. So you would think that a fun day on the lake with your friends should leave you with some funny stories to tell your children when they are old enough. But for one patient this weekend, it landed her in the hospital with urgent surgery and IV antibiotics...and did I mention pain...lots!

All you lake and river rats, take notes. This very pleasant young patient was enjoying a day on the lake when she cut her foot on broken glass on a sandy beach just at waters edge. She knew it was not just a small nick in the skin and immediately went to the local ER. She was treated and sent home with antibiotics and told to follow up with her physician to remove her stitches in a week. Within 3 days her foot become so red, swollen and painful that she took herself to another ER where she was admitted with a severe foot infection.

So what happened? She did all the right things. Unfortunately, she needed more aggressive antibiotics. What she had is called a laceration which is a traumatic cut in the skin. It it normally deeper than skin and often requires stitches to close the injury. Appropriate care of any laceration includes a deep cleansing to remove dirt and debris and any foreign objects that might be sitting in the wound. Sometimes this can be done in the ER, but there are times that cuts may need to be taken to the operating room for more aggressive "washing" or what we call incision and drainage. Once the wound is clean and sutures or stitches are used to close the skin, then healing occurs within 10-14 days.

So what happened here? The lake is what happened! Lakes, rivers, oceans and stock tanks are full of water borne bacteria and with our 100+ degree weather certain bacteria are thriving. These bacteria are very aggressive, not killed with basic antibiotics and cause severe infection. They can lead to tissue loss or even limb loss in unhealthy patients.

If you do happen to cut your skin while enjoying water activities, don't ignore it. Seek treatment right away and make sure you get antibiotics and a tetanus shot to prevent a possible surgery in the future!

Ingrown Toe Nail Hell!

There is no question about it. You have dug on that ingrown toenail one too many times and it has just about had it! It is swollen and red and painful and you just can’t get it out this time. Where do you go from here? Well, to your podiatrist by golly!

An ingrown toenail is a toenail that simply looks like it is digging into the skin surrounding the nail (aka, into the “nail fold”). Ironically, you can have a nail that looks ingrown but is not painful. That is perfectly ok! It is the nail that decides to step it up a notch and cause irritation to the nail fold that becomes a problem! Squeezing your toes into the stilettos seen at the royal wedding may just provide all the irritation it needs to get the ball rolling!

If you have ever had an irritated ingrown nail, you know what I am talking about. It feels like absolute self-induced torture trying to dig those out with your handy-dandy nail clipper. If the clipper or the toe is not clean enough, you can end up inviting all the nasty critters for a visit and end up with a nastier infection.

Trust me on this one. If you have had to dig out an ingrown nail several times a year, it will not go away the longer you fuss with it. It is riskier to keep fussing with it than getting over to your podiatrist office to have it taken care of. What does that mean? Well, for one, it means cleaner and more precise instruments, expertise and resolution to the problem. That means you likely won’t get it back for the rest of your life with one visit!!

A podiatrist can perform what is known as a “matrixectomy”. The “-ectomy” part of that term means “removing” and the “matrix” part of the word means the nail root in question. We, in essence, remove the portion of the nail root that is growing the portion of nail getting ingrown. It is very precise; removing only what is needed to keep the nail from getting ingrown and leaves the remaining nail intact. For the most part, once it is healed with a little TLC on your part, it never looks like anything was ever done! Only a very small percentage of nails try to grown back in the section removed. Overall, a very, very successful permanent result to your chronic problem!

Leaving an ingrown nail to get infected is leaving it too long! An antibiotic will only work to temporarily relieve the symptoms. As long as the nail is growing into the skin, you will continue to have the problem. Don’t wait to get in to see your podiatrist at the first signs of discomfort. I have seen too many 60-year-old patients saying they wish they would have done this 20 years ago. Don’t let this be you!