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Dr. Fishco performs emergency trauma surgery of the foot and ankle as well as elective reconstructive surgery.
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Dr. Fishco makes an impression of your feet with plaster and then a laboratory manufactures custom made orthotic devices.


 
 
41818 N Venture Drive, #110
Anthem, AZ 85086
Phone: (623) 551-5000
 
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Dr. William Fishco
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PinPointe Laser Specialist

Cynosure's PinPointe FootLaser is an ideal treatment for nail fungus. Cynosure manufactures industry leading products used to address aesthetic concerns ranging from the removal of outdated body art to restoration of skin tone.

 
PATIENT EDUCATION

Plantar Fasciitis

Plantar fasciitis is a heel pain syndrome and is one of the most common maladies of the foot.  Most heel pain is due to a tight ligament-like structure in the arch called the plantar fascia.  This structure cannot stretch; therefore it pulls where it attaches to the heel bone.  Commonly, with x-ray, one can see extra bone formed at the attachment site on the heel.  This is known as a heel spur.  There are many techniques used to treat heel pain.

Ingrown Toenails

Disorders of the toenail are very common. When the nail begins to irritate the nail fold on the side of the toe, this is referred to as an ingrown toenail.  There are a number of reasons for a nail to become ingrown. Sometimes it is due to hereditary factors such has one having a very wide or spoon-shaped nail.  It may be due to an injury such as stubbing the toe causing the nail to irritate the skin, or most commonly it is the result of improper trimming of the nail. Nails should be trimmed straight across being careful not to wedge the corners back or trim the nail too short.  In more severe cases of ingrown nails, one can develop infection (paronychia) and/or a growth of proud flesh (pyogenic granuloma) on the nail fold which is very vascular and tends to bleed easily. Ingrown toenails can be fixed permanently as a simple in-office procedure.

Bunions

One of the more common disorders affecting the great toe joint includes bunions (hallux valgus).  A bunion is a boney protrusion on the side of the big toe joint which is really a deformity of the joint.  Hereditary reasons are usually to blame for bunions. Typically the more flexible your joints are (ligamentous laxity), the more likely that you will develop a bunion.   Part of the bunion deformity involves the big toe leaning towards the 2nd toe. In more severe cases of bunions, the big toe can undermine the 2nd toe causing the toe to cross over the big toe.  Generally speaking, bunions are progressive disorders which worsen over time. As the bunion gets larger, the big toe becomes more angled towards the 2nd toe.

Morton’s Neuroma

The most common nerve disorder in the foot is a Morton’s neuroma.  A neuroma is thickening of nerve tissue secondary to irritation.  The most common location of a Morton’s neuroma is between the 3rd and 4th metatarsals (the 5 long bones that connect the middle foot to the toes. Certain foot structures are more likely to develop a Morton’s neuroma.  Irritation of the never comes from the metatarsal heads pinching the nerve during activity. Symptoms include pain in the ball of the foot which can radiate to the 3rd and/or the 4th toes. Sometimes people relate numbness, burning, and/or or shooting pain to the affected toes.

Diabetic Foot Care

People with diabetes need extra care regarding their feet.  Everyone has a friend or relative who has had complications with their feet related to diabetes.  The reason that the diabetic foot is vulnerable generally includes a combination of peripheral neuropathy (burning, tingling, and numbness of the feet) which makes it difficult to feel pain and coupled with poor circulation.  When there is numbness in the foot, simple blisters, cuts, and scrapes can go unnoticed until the condition is more serious such as an ulceration (hole in the skin) and/or infection.  Infections are more difficult to treat in diabetics because bacteria like sugar (which is higher in diabetics) and diabetics can have compromised immune systems.  Anyone who has diabetes should have a Podiatrist.  At the very least, an initial examination can be done to determine if one is at risk for diabetes-related problems with their feet.  If not, then annual exams are recommended. Otherwise, regular 2-3 month exams and routine care for nails, corns, and calluses, is recommended.

Achilles Tendon Disorders

The Achilles tendon is the strongest tendon in the lower extremity.  Tendons are soft tissues that connect muscle to bone. There are three muscles that create the Achilles tendon – the medial and lateral heads of the gastrocnemius muscle and the soleus muscle.  The Achilles tendon, or sometimes referred to as the heel cord, attaches to the back of the heel.  Common disorders of the Achilles tendon include tendinitis, which is an inflammatory process involving the sheath and structures surrounding the tendon.  Tendinosis is a chronic degenerative process of the tendon which can cause thickening, split tears, and weakening of the tendon.  Another common problem includes pain on the back of the heel where the tendon inserts which can be associated with a heel spur (posterior heel spur). This is generally referred to as an insertional tendinitis.  

Hammertoes

Toes should be straight. However, when there is a bending of the toe causing a contracture at one or more of its joints, this is referred to as a hammertoe.  Hammertoes can be painful, especially if the shoe rubs the top of the toe causing a skin irritation which can lead to a corn.  Sometimes the tip of the toe can develop a corn if it is rubbing the shoe.  Hammertoes are generally caused by imbalances of the tendons that course the top and bottom side of the digit.  As one ages, one is more likely to develop hammertoes.  Sometimes, however, children develop hammertoes early on in life especially if there is a high arch foot type.

Pediatric Flatfoot

The arch does not fully develop until about 5 or 6 years of age. So, toddlers and young children tend to have a flat looking foot.  As a child develops beyond that age, a collapsed arch can be a cause of foot pain.  When looking at a child walk from behind, if you see most of his/her toes pointing away from the midline of the body, then there may be a problem.   There are two types of flat feet, flexible and rigid. Rigid flat feet are more difficult to treat and may even require surgery. Flexible flat feet can be managed with foot orthotics (appliances that go into a shoe to realign the foot to the leg).   Surgery is only considered when there is pain that is not resolved with various conservative treatments.

Plantar Wart

The plantar aspect of the foot is the bottom side. And therefore, plantar warts are warts that develop on the bottom of the foot.  Warts (verruca) are caused by skin viruses.  These viruses are everywhere in the environment and you cannot hide from them. Some people are not susceptible to the virus and never get warts even though they are exposed to the virus.  In those that develop warts, one can appreciate hard lumps of skin that can have a unique appearance such as crumbly looking skin, black dots in the center, or they can bleed easily.  

Pediatric Heel Pain

Children between the ages of 9 and 13 are at risk for heel pain.  The reason is that at this age, the heel bone is maturing and there is a growth center that can be irritated by the Achilles tendon.  The growth center of a bone is called the apophysis.  When the growth center is inflamed, it is termed apohphysitis.  The heel pain that children get is called calcaneal (heel) apophysitis. This is also referred to as Sever’s Disease. Aggravating factors include running, sports, and wearing cleats. 

Thick Toenails

There are two reasons for nails to become diseased which can cause thickness, irregularity, and discoloration.  Fungal infections of the nails are caused by dermatophytes.  Onychomycosis is the medical term for fungal nails. Another cause of nail disease includes nail root trauma.  An injury to the nail can cause permanent damage to the root (matrix), which dictates the way the nail will grow.  It is difficult to look at a nail and tell which thick nail may be caused by fungus or nail root damage.  Therefore, the only way to know for sure whether or not there is a fungal infection is to take a sample of the nail and send it to a lab where it can be examined under a microscope looking for fungal elements.  If there is fungus in the nail, then the nail can be treated with an antifungal medication. If there is not a fungal infection, then there is no cure for a diseased nail caused by root damage.

Stress Fractures

Stress fractures in the foot are common. There are two types of stress fractures. In young healthy individuals, stress fractures are caused by over use.  This type of stress fracture is termed a fatigue stress fracture.  Too much load to a bone can cause it to break. This is seen with military recruits and runners often termed a “march fracture.”  The other type of stress fracture is called an insufficiency stress fracture. This type is seen in older more sedentary individuals who have compromised bone stock with osteopenia or osteoporosis. In these individuals, normal activities can cause the stress fracture.  Stress fractures are commonly seen in the metatarsal bones, the heel, and the fibula bone (smaller of the two leg bones that connect to the foot).  It can take up to 2-3 weeks to visualize a stress fracture on an x-ray because what one sees on x-ray at first is not the actual fracture, but the healing of the fracture which is termed bone callus.

Shoes

My patients always ask me what brand of shoes I should buy.  There is no easy answer for that since all shoe manufactures make good shoes and bad shoes. So here is what you need to know.  There are three main things to look for in a good shoe. Number one, it should have a very stiff midsole, meaning that the shoe should not bend easily.  Secondly, the shoe should not twist.  If you hold the heel of the shoe in one hand and the toes in the other, give it a twist.  If the shoe resists twisting, then that is good.  Finally, the heel counter, which is the part of the shoe that touches the back of your heel, should be rigid. So you should not be able to push down the counter with your thumb.  If your shoe has the properties of a slipper, which you can bend, twist, and roll up in a ball, then it’s time to go shopping for better shoes.  

More Education

 

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