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Stacy L Witfill DPM

~ Stacy Witfill

Stacy L Witfill DPM

Tag Archives: Dr. Stacy Witfill

Ankle Sprains: It’s not always “Just a Sprain”

19 Wednesday Jun 2019

Posted by Stacy Witfill in Uncategorized

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Dr. Stacy Witfill, Stacy Witfill, StacyWitfill

Ankle Sprains: It’s not always “Just a Sprain”.
Unresolved Lateral Ankle Pain after an inversion type of ankle injury is often overlooked and misdiagnosed. Initial evaluation of ankle injuries should consist of detailed clinical history, meticulous anatomical clinical exam, plain films, and possible ultrasound/MRI if tendon injury, occult fracture, or osteochondral injury is suspected. Osteochondral lesions of the talus when detected early have a better chance of resolving with conservative treatment. Conditions that mimic lateral ankle sprain include impingement lesions, sinus tarsi syndrome, peroneal tendon pathology most commonly in the form of longitudinal tearing, tarsal coalitions, occult rear foot fractures, talocalcaneal sprains without or with instability, osteochondral lesions of the talus, and syndesmosis sprains.
In my experience the most common residual ankle pain post sprain is longitudinal tearing of the peroneal tendon. The second most common is sinus tarsi syndrome. The third most common is osteochondral lesion. On occasion a superficial peroneal nerve entrapment can be a source of residual pain as well. In my private practice, however, early diagnosis of longitudinal tearing of the peroneal tendon via clinical history, exam and ultrasound exam provides better long term outcome with earlier intervention. In addition osteochondral lesions are quite evident in the early stages of post sprain period and MRI and subtle plain film changes provide earlier intervention and minimize the need for surgical intervention. Sinus tarsi syndrome can usually be treated with cortisone injection and short period of immobilization of the subtalar and midfoot joint.
The importance of accurate and early diagnosis of ankle sprains cannot be overstated. True isolated ankle sprains will resolve quickly with appropriate periods of rest followed by rehabilitation and support. If co existing pathology is evident early diagnosis and appropriate treatment is imperative to minimize long term adverse sequela.

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Chemical Matrixectomy by Stacy Witfill DPM

25 Wednesday Feb 2015

Posted by Stacy Witfill in Medicine

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Dr. Stacy Witfill, Stacy Witfill

Onychocryptosis or more commonly referred to or known as ingrown nails can be painful and dangerous for high risk diabetic patients and patients with peripheral vascular disease. The condition can be painful for any patient and often “even the bed sheets cause the toe to hurt” The following article outlines a permanent procedure for removing ingrown toenails. Diabetic patient should first be assessed for peripheral vascular disease and glycemic control before performing the procedure. Consideration should be made to the kidney function of patients as 5-10 percent of these patients will develop post-operative infections and require systemic antibiotics. These considerations should be discussed with the patient during the pre-operative visit.

In addition care should be taken to fully evaluate the patient for any associated benign or malignant tumors involving the nail before performing a chemical matrixectomy. Although rare, any unusual “proud flesh” or unusual pigmentation of the nail bed should be biopsied before performing a chemical matrixectomy. Such benign tumors include warts(periungual and subungual), fibroma, neurofibroma, pigmented nevus, pyogenic granuloma(periungual and subungual), glomus tumor,myxoid cyst, acquired digital fibrokeratoma,keratoacanthoma, bone cysts including subungual exostosis,osteochondroma,enchondroma. Malignant tumors include bowens disease,metastatic carcinoma most commonly associated with a club appearing nail, basal cell carcinoma,malignant melanoma, and squamous cell carcinoma(the most common malignant cancer see associated with ingrown nails. If there is any clinical suspicious findings which could indicate any of the above conditions the patient should be advised of this and appropriate biopsy carried out.

There are also associated biomechanical etiologies of ingrown toenails that can be considered before performing a chemical matrixectomy. For example hallux abducto valgus deformity that is severe enough to cause the lateral border of the nail to impinge against the medial border of the 2nd toe causing the nail fold to overgrow the nail plate and thus causing the nail margin to embed within the tissue. In this situation the patient should be at least advised on the underlying etiology and at least given the option to trying a simple pad between the toes as an alternative to a chemical matrixectomy.

Performing a chemical matrixectomy

Infiltrate 3 cc of lidocaine 2% in standard hallux block. Standard prep with iodine. Introduce a freer elevator under the hyponychium and the eponychium Using a longitudinal nail splitter, create a vertical incision into the nail plate the level of the proximal nail plate. Utilize a 61 blade to finish the cut under the eponychium. Remove the offending nail border with a straight hemostat. Apply 89% phenol for 30 seconds. Repeat 2 applications of phenol. Rinse copiously with alcohol. Utilize a currette and remove excess tissue. Apply silvadene with a dry sterile compressive dressing. Follow patient as needed every 1-2 weeks.

 

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Gallery

Flowers by Stacy Witfill

25 Wednesday Feb 2015

Posted by Stacy Witfill in Photography

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Dr. Stacy Witfill, flowers, Gardens, StacyWitfill

Stacy Witfill

This gallery contains 41 photos.

Gallery

3 days by Stacy Witfill

20 Friday Feb 2015

Posted by Stacy Witfill in Photography

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Dr. Stacy Witfill, Stacy Witfill, Sunrise, Sunset

Gallery

Bird and Sunrise by Stacy Witfill

07 Saturday Feb 2015

Posted by Stacy Witfill in Photography

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Dr. Stacy Witfill, Dr._Stacy_Witfill, Stacy Witfill, Stacy_L_Witfill, Stacy_Witfill, Sunrise

stacy witfill

This gallery contains 55 photos.

Chemical Matrixectomy by Stacy Witfill DPM

18 Sunday Jan 2015

Posted by Stacy Witfill in Medicine

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Dr. Stacy Witfill, Stacy Witfill

Onychocryptosis or more commonly referred to or known as ingrown nails can be painful and dangerous for high risk diabetic patients and patients with peripheral vascular disease. The condition can be painful for any patient and often “even the bed sheets cause the toe to hurt” The following article outlines a permanent procedure for removing ingrown toenails. Diabetic patient should first be assessed for peripheral vascular disease and glycemic control before performing the procedure. Consideration should be made to the kidney function of patients as 5-10 percent of these patients will develop post-operative infections and require systemic antibiotics. These considerations should be discussed with the patient during the pre-operative visit.

In addition care should be taken to fully evaluate the patient for any associated benign or malignant tumors involving the nail before performing a chemical matrixectomy. Although rare, any unusual “proud flesh” or unusual pigmentation of the nail bed should be biopsied before performing a chemical matrixectomy. Such benign tumors include warts(periungual and subungual), fibroma, neurofibroma, pigmented nevus, pyogenic granuloma(periungual and subungual), glomus tumor,myxoid cyst, acquired digital fibrokeratoma,keratoacanthoma, bone cysts including subungual exostosis,osteochondroma,enchondroma. Malignant tumors include bowens disease,metastatic carcinoma most commonly associated with a club appearing nail, basal cell carcinoma,malignant melanoma, and squamous cell carcinoma(the most common malignant cancer see associated with ingrown nails. If there is any clinical suspicious findings which could indicate any of the above conditions the patient should be advised of this and appropriate biopsy carried out.

There are also associated biomechanical etiologies of ingrown toenails that can be considered before performing a chemical matrixectomy. For example hallux abducto valgus deformity that is severe enough to cause the lateral border of the nail to impinge against the medial border of the 2nd toe causing the nail fold to overgrow the nail plate and thus causing the nail margin to embed within the tissue. In this situation the patient should be at least advised on the underlying etiology and at least given the option to trying a simple pad between the toes as an alternative to a chemical matrixectomy.

Performing a chemical matrixectomy

Infiltrate 3 cc of lidocaine 2% in standard hallux block. Standard prep with iodine. Introduce a freer elevator under the hyponychium and the eponychium Using a longitudinal nail splitter, create a vertical incision into the nail plate the level of the proximal nail plate. Utilize a 61 blade to finish the cut under the eponychium. Remove the offending nail border with a straight hemostat. Apply 89% phenol for 30 seconds. Repeat 2 applications of phenol. Rinse copiously with alcohol. Utilize a currette and remove excess tissue. Apply silvadene with a dry sterile compressive dressing. Follow patient as needed every 1-2 weeks.

 

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