Neuropathy is a term used to describe any problem related to the nerves. Most problems in the legs are considered peripheral nerve problems meaning the CNS is not involved but in the legs themselves. Sometimes the lower back can contribute to the pain or neurologic symptoms in the leg and acts as a “double” crush. Think of nerves as a garden hose and the spigot is the spine and at the end of the hose are the toes. Any kink or “crush” of that hose/nerve will cause some damage and there can be multiple crushes, which can make things more difficult to achieve a successful treatment outcome. Diabetics are more prone to neuropathy and should be monitored regularly because if there is loss of sensation this can lead to ulcer, infection and even loss of limb. Many cases of neuropathy are often called idiopathic. This term means that there is no known cause. In most cases, this is NOT the case. Usually, there is an entrapment or compression of the nerve(s). A nerve entrapment can be easily identified by a peripheral nerve surgeon, when present in the leg. Dr. Ricciardi has been specially trained to diagnose and treat these problems. Many times other doctors will not be able to diagnose these nerve entrapments and often, special studies such as MRI or nerve conduction studies will not identify the problems. Also, if there is a history of carpal tunnel or arm nerve problems then it is more likely to be present in the legs.

Common sites of nerve entrapments in the legs:

• Tarsal Tunnel – this is like carpal tunnel in the wrist. The nerves on the inside of the ankle become stretch and compressed. This can be aggravated by flat, or hyper-pronated feet. The medial calcaneal nerve is also present here and can be a problem.
• Common Fibular Nerve – this is a nerve behind the head of the fibula near the knee. It is prone to entrapment and can also cause lower back pain and restless leg syndrome symptoms. Cramping in legs can also be present.
• Superficial Fibular Nerve – this is a branch of the common fibular nerve that is in the anterior-lateral leg and extends over the ankle into the foot. It is often injured in sports or ankle fractures but can also be a problem in athletes.
• Tibial Nerve – this nerve starts in the back of the knee and continues behind the calf muscles and eventually turns into the tarsal tunnel. Cramping is often present in the calf area.
• Deep Peroneal Nerve – this nerve is present on the top of the foot just below the ankle and can often be a problem with shoes or if there is a spur present near it.
• Saphenous and Sural Nerves – these are purely sensory and run on the inside and outside or the leg respectively. They can be injured during any surgery or injury.

Treatment if neuropathy/entrapments:

First, the proper diagnosis of the problem is made by a combination of the history, exam, and diagnostic testing. Many times there can be hormonal imbalances or other medical issues. Blood tests will often be ordered, and also a 3mm biopsy of the skin on the leg is often needed to rule out small fiber neuropathy, which is another kind of neuropathy. Diagnostic local anesthetic blocks are used to help isolate the involved nerves. In 70% of entrapment cases, surgical decompression is the treatment of choice in the other 30% they can respond to specialized physical therapy known as nerve gliding or nerve flossing. Topical prescription creams are also used to help with pain. In some cases, prescription vitamins are also prescribed as well as other medication to help deal with the pain of neuropathy. Most of the nerve surgeries are fairly quick surgeries and the patient is back to regular activity in a few weeks.

Your feet are covered a good part of the day. If you are diabetic, periodic screening is important for good health. Numbness is often another sign of diabetic foot and can mask a sore or wound.

Toenail fungus infections can be extremely unsettling and embarrassing, but they’re a lot more common than you might think. In fact, the American Academy of Dermatology estimates that about 12% of Americans are affected, with older adults especially likely to carry the pathogen.

Traditional treatments for fungal nails are spotty at best, and carry a risk of potentially serious side effects. However, cold laser therapy has dramatically improved the situation, and treatment is now much safer and boasts much higher success rates.

What Causes Fungal Nails?

Toenail fungus is caused by dermatophyte fungi—the same microorganisms responsible for athlete’s foot, ringworm, jock itch, and other common skin conditions. If you have athlete’s foot, the fungi can sometimes get underneath the nail through tiny cracks or cuts. It’s also possible to spread the fungi from person to person through indirect contact with infected surfaces—gym or pool floors, towels, even salon tools.

Zap Your Fungus with Laser Therapy

At Foot and Ankle Specialists of Nevada, advanced cold laser therapy is the treatment of choice for fungal nails, although we still offer older methods like oral and topical antifungal medications. It offers many advantages over previous procedures.

How It Works

The beams of light generated by the laser are tuned at a precise wavelength, power, and frequency that allows them to pass through the nail plate and attack the fungus underneath—all without harming your own cells. This makes it both highly safe and highly effective as a method of treatment.

One laser session requires about 30-45 minutes, though times can vary depending on how many toes are being treated and how severe the condition is. No anesthetic is required and you should not feel any pain or discomfort. Once the session is over, you can go right back home or to work—no down time. Some patients may only need a single treatment; however, as many as four treatments might be necessary to fully eradicate the fungus.

Once the fungus has been eliminated, a new, healthy, clear nail will grow out it its place. Although you will likely see some level of aesthetic improvement very quickly, it may take several months for the portion of the nail that has already been damaged to grow out and away.

Injuring Your Feet and Ankles

Broadly speaking, there are two main types of foot and ankle injuries: traumatic (or acute) injuries, and overuse injuries.

Acute injuries happen in an instant—a big hit, a sudden stumble, an unfortunate hyperextension—and result in immediate (and often severe) pain and damage. On the other side, overuse injuries slowly build up over time, and dozens or hundreds of tiny impacts, stresses, and wear and tear weaken muscles, soft tissues, and bones.

Common causes of foot and ankle injuries include wearing improper shoes or equipment, rapidly changing your workout routine or increasing mileage/difficult too quickly, and not taking enough rest time between workouts.

When you hurt yourself on the sports field (or just going through life), you want a team in your corner. Because of our training and our expansive range of treatment options, we’re able to provide personalized and effective care. To schedule your appointment, give us a call at (702) 213-9093.

Treatments for Nerve Pain

Unlike your phone, getting the network back online after an issue isn’t always as easy as plugging in an adapter. Nerve damage from neuropathy or compression tends to worsen with time, and the longer you wait for treatment, the more likely the damage will be permanent, at least on some level.

For mild or early-stage cases, the first step will likely be conservative. Depending on the cause of your nerve pain, conservative care may take the form of medications (both oral pills and topical creams) physical therapy, custom orthotics, or even a change in footwear.

However, in the last several years a variety of new technologies and techniques have emerged to help manage (and even cure) nerve pain better than ever before. We are proud to offer these options to our patients.

• Electrical stimulation. This extremely promising and effective treatment option uses electrodes placed on the skin to generate a gentle electric current processed by your nerves. These electric signals provide numerous benefits, including inflammation reduction, improved blood flow, and increased cellular regeneration. In some cases, as the nerve fibers get used to receiving and transmitting these signals, they can actually begin to re-establish broken connections with other nerves and improve function.
• Nerve decompression surgery. In about 70% of cases where a nerve has been trapped, decompression surgery is the treatment of choice. Once we identify the precise source of the problem (using diagnostic techniques such as blood tests, biopsies, and local anesthetic blocks), we can perform the surgery. Most are fairly quick, and you can go back to your regular activities within just a few weeks.
• Laser therapy. Our cold laser can help soothe nerve pain and boost function by reducing inflammation and improving blood flow.
• Shockwave therapy. The high-pressure waves emanated by this tool have been shown to reduce the pain felt by nerve fibers.

No one is better equipped to identify and treat nerve pain conditions in the feet and ankles than the team at the Foot & Ankle Specialists of Nevada. To schedule your appointment with us at either of our area offices, please call (702) 878-2455.

Causes of Heel Pain

Heel pain is not caused by a single condition, and usually can’t be traced to a single incident or injury. More likely, your heel pain is the result of multiple small traumas over time. Each step can place a force on heels equal to anywhere from one and a half to three times your own body weight. Days, weeks, even years of wear and tear from physically demanding occupations, athletic participation, and other activities will slowly build the pain and pressure.

Heel Pain Treatment Options

The good news is that, 9 out of 10 times, conservative treatments like icing, stretching, and custom orthotics will help you ease the pain of plantar fasciitis, along with most other forms of heel pain. For tougher pain, we may prescribe more aggressive treatments, including:

• Cortisone injections, which provide stronger pain relief to the aching tissues than over-the-counter medications.
• Shockwave therapy. This advanced technology uses high-intensity pressure waves to stimulate injured tissues, which reduces pain felt by nerve fibers, increases circulation, and triggers stem cells to accelerate the healing process.
• Cold laser therapy. The laser emits a beam of light tuned to a highly precise wavelength and intensity. At this frequency, the laser is able to penetrate deep into soft tissues to fight inflammation, improve blood flow, remove waste products, reduce pain, and stimulate tissue repair.
• For most heel pain conditions, surgery is a last resort that is only rarely required, for the most severe cases. The exception is tarsal tunnel syndrome, which is usually best treated with a decompression surgery.

It is critical to understand that not all heel pain is created equal. Even if the symptoms seem the same, the causes may be very different. Each case needs to be fully evaluated by an expert in order to ensure you get the most effective treatment.

Breaking news: Foot and ankle fractures can lead to major pain, distress, and disruption in your life. Foot bones are tough, but they’re far from impervious to sudden impacts, severe twisting, auto accidents, or even just plain wear and tear.

If you break a bone in your foot or ankle, the last thing you want to do is keep walking on it. Get off your feet, get to the emergency room if you have to, and book an appointment with the Foot & Ankle Specialists of Nevada as soon as possible. We also take same day appointments.

Types of Fractures

Physicians classify fractures in many different ways—by location, bones effected, severity, etc. Generally speaking, there are three broad categories:

• Stress fractures are hairline cracks in the surface of a bone. They are usually caused by overuse and are common in load-bearing metatarsal bones of the arch. They usually don’t need surgery or even casting, but will need plenty of rest time to heal.
• Closed fractures. In closed fractures, the bone is “fully” broken, but has not broken the skin or done significant damage to the surrounding tissue. Closed fractures may be stable, in which the broken bone remains in the correct position and alignment, or unstable, in which at least one part of the bone has shifted out of place.
• Open fractures. Here, a significant unstable fracture has broken the skin and severely damaged surrounding soft tissue structures. If you experience an open fracture, you should attempt to stop the bleeding using firm pressure with a clean cloth, but you should not attempt to pop the bone back in place. Have someone call 911 immediately.

Signs That You May Have Broken a Bone

It’s not always immediately obvious that you’ve broken a bone. Often, stress fractures and stable closed fractures are shrugged off and misattributed to sprains. However, if you note any of the following symptoms, you should consider that a fracture is at least possible:

• Pain, often severe, at the site of the break
• Swelling
• Bruising
• Inability to walk or put weight on the foot

What to Do If You Suspect a Fracture

If you believe that a bone in your foot or ankle may be broken, it is important to avoid putting any weight on the foot and begin RICE treatment (Rest, Ice, Compression, and Elevation):

• Do not bear weight or aggravate the injury.
• Do this for about 20 minutes at a time, on and off, as necessary.
• An athletic wrap around the injury will help control swelling.
• Keep your feet propped up, over chest level if possible.

Next, you should contact our office and schedule an appointment as soon as possible. Fractures that are not treated properly can lead to post-traumatic arthritis, chronic pain and weakness, and other long-term complications and consequences.

Treating Foot and Ankle Fractures

Professional treatment from a physician will vary considerably based on the location and type of the break, as well as the extent of the damage to both bone and surrounding tissue. Your activity level, health, and long-term goals may also be a factor in determining the best treatment protocols.

• Stress fractures can usually be treated with simple rest. You can bear weight, but avoid running, playing sports, or engaging in any strenuous activities that would cause pain or aggravate the injury.
• Serious stress fractures and many closed, stable fractures may need an immobilization device—a leg cast, walking boot, or similar device. This will protect the bones from further damage while they heal.
• More complicated or at-risk fractures often require surgery to reposition and/or reconstruct the damaged bones. We may need to use hardware such as pins, screws, wires, or plates to hold the reconstructed bones and joints in place while they heal.

The board-certified physicians of the Foot & Ankle Specialists of Nevada have extensive training in both conservative and surgical treatment of foot and ankle fractures, including advanced techniques in reconstructive surgery. Although we always try to correct your issue non-invasively, we are equipped and trained to provide the best and most current treatment options, whatever your needs may be.

To schedule your appointment with our team in Las Vegas, NV, please call (702) 213-9093 today.

Common Child Foot Pain Conditions

Although far from a comprehensive list, some of the most common pediatric conditions we treat include:

• Intoeing / Pigeon Toes. Your child walks with toes that appear pointed inward, and may also sit in the “reverse W” position. This condition may be caused by an inward rotation in the foot bones (metatarsus adductus), shin bones (tibial torsion), or hip bones (femoral anteversion). Some cases of intoeing may correct spontaneously without treatment, while others may require treatments such as physical therapy and orthotics.
• Flat Feet. Due to soft and flexible bones, children commonly have a flexible flat foot in which the arch “collapses” under body weight but returns in other circumstances. Most of the time, this corrects itself eventually. However, there are other congenital flat foot conditions (both flexible and rigid) that will not self-correct and will require treatments such as orthotics, stretching, physical therapy, or surgery.
• Toe Walking. An overly tight Achilles tendon or other developmental issue may cause your child to do most of their walking on tiptoes. If this continues to happen beyond age 2, your child should be evaluated. More serious treatment remedies (including physical therapy and potentially surgery) may be indicated if the problem persists until age 5 or 6.
• Heel Pain. Young adolescents, usually from about age 9 to 14, are especially susceptible to a heel pain condition known as Sever’s disease, or calcaneal apophysitis. At this age, the relatively soft growth plate of the heel bone is exposed and growing rapidly. This combined with a high level of physical activity may lead to swelling and irritation in the growth plate. Most of the time, this can be treated conservatively.
• Ingrown Toenails. In this condition, the corner or edge of a nail grows in rather than out, digging into soft flesh. This may produce pain or even an infection. Recurring ingrown toenails in kids is generally evidence of a genetic predisposition. We will remove the ingrown edge and then perform a chemical destruction of that part of the nail root. This keeps the problem from returning, and the procedure both has a high success rate and is usually not painful.
• Warts. Kids often develop warts on hands and feet, due to underdeveloped immune systems. Sometimes warts go away on their own, but if your child’s warts are causing pain, embarrassment, or have lasted for at least 6 months, they should be treated. We offer a range of options, including topical acid therapy, laser treatment, or sometimes oral medications. Deep, painful warts may need to be excised surgically.

What Is a Bunion?

Bunions are very common foot deformities that affect the side of the foot and the largest toe. A large, bony bump begins to form along the foot at the joint at the base of the great toe—where it meets the long midfoot bone known as the first metatarsal. At the same time, your large toe begins drifting in the opposite direction, pressing into (or even crossing over or under) the second toe. 

Bunion Surgery

There are many different types of bunion surgeries. The specific procedure or procedures used will be selected based on the severity of the condition itself, as well as any other considerations about your general health, personal goals, or activity level. 

Additional Surgical Procedures

Sometimes, the surgeon may need to perform a secondary procedure alongside the main bunion surgery in order to provide the best outcome. The decision may need to be made at the time of surgery. These might include:

• Akin Osteotomy—a small wedge of bone is removed from the big toe in order to allow it to lie straight. This may be done with a minimally invasive approach, or using traditional staple fixation.
• Sesamoid Removal—the two tiny sesamoid bones act as “pulleys” underneath the big toe joint to help generate power. However, they often become dislocated as a result of a bunion. One of both may need to be removed.
• Second Toe Surgery—sometimes, the surgeon will also need to correct a dislocated second toe or perform other surgical procedures as needed. The need for a second toe surgery may not be apparent until the actual surgery is in progress. Any such decisions are made with your best interests in mind.

Our doctors offer extensive experience, specialized training, and board certifications in complex foot reconstruction and fixation techniques. We are proud to report a 95% success rate with our bunion surgeries. Among those who get bunion surgery, fewer than 1 in 20 suffer a recurrence.

If you are struggling with bunion pain, contact us for a consultation and discussion of your treatment options. You can schedule at our offices by dialing 702) 213-9093.

Treatment and Restoration for Ankle Pain

Our team understands that each person and each condition are different. The best treatment plan for you personally may vary based on the cause and severity of your chronic ankle pain, as well as your personal and professional needs.

Treatment options may include:

• Physical therapy. Stretches and exercises are designed to relieve pain, increase range of motion, and improve strength and stability in the supporting muscles and tendons. This can provide temporary support to a weak or unstable ankle.
• Shockwave therapy. This advanced device uses high-intensity pressure waves to reduce pain and stimulate healing.
• Laser treatment. Our state-of-the-art cold laser improves oxygen transfer, tissue repair, and soothes pain.
• Nerve decompression. May be necessary if your chronic pain is caused by a nerve issue.

When you visit our practice, you can expect a thorough examination, accurate diagnosis, and individual treatment from the best trained specialists in the area. To schedule your appointment, please call (702) 878-2455.