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Posts for tag: treatment options

January 09, 2015
Category: F.Y.I.

Sclerosing Injections are a series of injections often used to treat a painful Morton's Neuroma in the foot.  A Morton's Neuroma is a nerve inflammation or neuritis that occurs when a nerve on the bottom of the foot, usually between the third and fourth toes, becomes compressed or otherwise irritated and enlarges.  It is NOT a tumor, despite the name given to it many years ago by Dr. Morton.  Pain and numbness starting in the ball of the foot and radiating into the toes is a common symptom, and it often becomes worse as the nerve becomes more inflamed or enlarged.  There are several ways to treat neuromas, with surgery being done less and less often.

 Steroid (cortisone) injecions and orthotic devices are probably used in the majority of cases first, especially if padding and changes in shoes do not help.  Unlike steroid injections which are given to shrink the nerve, often temporarily, sclerosing injections are given to cause a chemical neurolysis of the nerve, basically making the nerve no longer work.  While nothing is successful 100% if the time, a series of sclerosing injections, often between 3 and 7 of them spaced 10 to 14 days apart, is often very helpful in reducing and often eliminating the pain, numbness, burning, and tingling of a neuroma.

  Typically, a very small amount of the medication, often less than 1.0cc, is infiltrated directly into or on the nerve.  It is helpful to use ULTRASONIC GUIDANCE for this treatment to be sure the medication is right at or in the nerve.  With steroid injections, a larger amount of fluid is injected near the nerve, so that the medication "bathes" the nerve.  It is more important with a sclerosing injection to give the medication right at or behind the bifurcation (the y-shaped area where the nerve splits into two branches). 

A very small needle can be used for this, usually smaller than that used for a steroid injection, as long acting steroid medications are "thicker" and are not easily administered through a very thin needle.  The procedure takes only a few minutes, and the patient is helpful in communicating with the doctor when she feels the doctor is "getting close to the nerve."  Sharp, electrical shock type pains, which are relatively brief, will tell the patient the needle is very close to the nerve.  The medication is given in that spot, and then the procedure is over.

  The sclerosing mixture used is often a mixture of absolute alcohol, Marcaine (a long acting anesthetic), and epinephrine.  In the U.S., it is common to use a 4% solution, but in europe, where the procedure has been done for a much longer period of time, high concentrations of the medication are used.  This increases the effectiveness, and may reduce the number of injections needed, but it does carry some risk of "burning" the skin.  I, personally, have found that a 10% mixture works well in a majority of cases, and have had no untoward effects with that strength.  I have heard of mixtures as high as 20% being used in Europe, with a high success rate, but also a sometimes unacceptable rate of side effects.  In any case, the sclerosing injections are usually given every 10-14 days until the patient sees a nearly complete resolution of symptoms.  I have found, in my practice, that anywhere from 3 to 7 are needed.  We usually then evaluate the patient several weeks to a few months later, to be sure there is no recurrence.

Dr. Richard S. Eby

(423) 622-2663

January 04, 2015
Category: Uncategorized

Plantar fasciitis and Achilles Tendonitis are two of the most common painful problems that affect the foot and ankle.  While there are MANY conservative treatment options for both conditions, many conservative treatments give TEMPORARY and/or PARTIAL results.  The use of high energy pulses to treat heel pain is NOT a new phenomenon.  In that late 1990's, and early 2000's, SHOCKWAVE THERAPY became a very effective and somewhat popular way to treat these problems, especially Plantar Fasciitis, which is extremely common, and for which surgical intervention often reveals unpredictable results.  Shockwave Therapy became less and less popular as the cost of these treatments were often as high as $2000 per treatment, and usually NOT covered under traditional health insurance.  In the past few years, less expensive and more portable units to transfer kinetic energy into the body have come on the horizon.  RADIAL PULSE THERAPY delivers high energy pulses for 1.Efficient energy transfer to effect muscle tone. 2.Treatment of muscle aches and pain. 3. Increasing localized blood circulation.  One of the radial pulse therapy units is marketed under the name "EnPuls."  While it can be used for back pain and upper extremity complaints as well, my expertise with this unit is in foot and ankle pathology.  I, specifically, have found this unit very helpful in the treatment of PLANTAR FASCIITIS and ACHILLES TENDONITIS with or without heel spur and bursitis.  Usually about five treatments are needed, spaced about 7-10 days apart, to give significant and lasting relief.  Unlike traditional shockwave treatment, there is NO need for anesthesia, either local or general.  The treatment is not painful, but may be slightly uncomfortable, especially over bony prominences such as the back of the heel.  Additionally, there is some improvement in heel pain, almost immediately.  While it still may take a few days to see a marked reduction in symptoms, the pain in the heel typically does not increase for a few days or weeks, as has occurred in many with traditional shockwave therapy.  Like traditional shockwave therapy, the patient should NOT consume oral anti-inflammatory medication (prescription or over the counter meds - including aspirin, Ibuprofen, or naproxen) for a period of time after the treatment(s).   In those cases where other conservative treatments have not been effective, Radial Pulse Therapy with the enPuls (Zimmer Medizin systems) has been a welcome addition treating heel pain, and can often eliminate the need for surgery.


Richard S. Eby, DPM

(423) 622-2663


October 13, 2014
Category: Laser Treatments

Ugly Toenail Syndrome

I want normal toenails, can you help me?

Have you been suffering from the discomfort and embarrassment of toenail fungus? If you visit your local pharmacy, you will find many over-the-counter options for treatment of this condition.  However, these often do not address the issue, especially if the fungus has already spread into the nail.  Prescription medicines are also available, but they also have limited effectiveness, and the side effects can cause permanent liver damage.

Dr. Eby is happy to offer a safe and pain-free option for the treatment of fungal nails:

Laser treatmentAt our office we effectively treat fungal toenails by utilizing the Q- Clear laser. Visit our office three times over the course of three months, and you’ll be on your way to fungus free toenails.  Each affected nail is treated for 1 painless minute, and the results will knock your socks off!

Call (423)622-2663 today to schedule an appointment at our Chattanooga office.  You can also visit our website and request an appointment online.

What is causing your toenails to become discolored, thick and brittle?

Have you inspected your toenails lately?  Many people rarely look at their feet and can later suffer from foot conditions that, if caught early, could have been easily treated.  Toenail fungus or onychomycosis is one of these common foot issues.

All fungi are not created equally.  While some actually aid the body, others can create infections.  One particular group called dermatophytes is the cause of most nail infections.  Other organisms like molds and yeasts can also cause this type of condition.

Along with environmental circumstances, there are other risk factors that increase a person’s chances of fungal nails.  The biggest contributor to your risk is age.  Certain natural changes that occur with age affect the ability of the feet to fight off fungal infections.  Over time the growth of nails slows which also puts the toenails at greater risk of infection.   As we get older, the circulation in the feet is diminished.  This means that it is more difficult for the body’s defense system to take action when it is being attacked.  This is also a concern for people with diabetes and those that have illnesses that impact their immune systems.  Other high risk scenarios include:  working in a humid place, sweaty feet, going barefoot in public places, skin conditions that cause cracking (such as psoriasis), injured nails, and unsanitary pedicures.

Want to prevent toenail fungus?

Preventing infection can be difficult, because these tiny, living things cannot be seen by the naked eye, and they do not need light to grow.  Their size or lack thereof, allows them to use entry points (cuts or cracks) that may not even be visible to the human eye.  The right conditions promote the growth of fungi:  warmth and moisture are the key ingredients for their breeding.

There are different types of nail fungus, but the early signs are typically yellow or white specks beneath the edge of the nail.  Stopping the spread of nail fungus is easier at the onset.  If left untouched, the infection goes farther into the nail, and will cause more discoloration, thickening and crumbling.  The affected nail may actually separate from the toe, and you may notice a foul smell as well.

Because of these factors, it is important to maintain healthy cleaning practices. This can be done by:

Clean your feet daily – By cleaning your toes daily you can keep your toenails clean. It is important that you do not scrub too hard and scratch the nail. Scratching the nail will make the nail vulnerable to infection.
Wear effective socks – Socks can help reduce moisture around your feet. The best kind of sock for this is a synthetic sock. By doing this you will eliminate the environment needed for the fungi to live.
Allow your shoes to dry out – Since the fungi thrive in moist environments, a dry environment inside the shoe can stop the fungal infection from multiplying and surviving.
Do not share shoes – Toenail fungus is contagious and can be spread through contact. If you wear a shoe infected with toenail fungus, you could infect yourself.

Prevention is one of the best treatments. By eliminating the cause you can help resolve the problem. If you are beginning to develop toenail fungus, do not worry! Dr. Eby and his staff can help you stop the condition from progressing.


October 22, 2012
Category: Heel Treatments

Heel pain is very uncomfortable for everyone. Millions of people suffer from chronic heel pain, especially in the morning.  Heel pain is also known as Plantar Fascitis. During rest, the Plantar Fascitis tightens and shortens. When body weight is applied, the Fascia must stretch and quickly lengthen, causing micro-tears in the Fascia. Over stretching of the Plantar Fascia is more likely under the following conditions:


1. Excessive pronation ( flattening of the arch)

2. Walking on hard surfaces for long periods of time.

3. Excess weight or pregnancy

4. Tightening of the calf muscles

There are several different options for this issue. There are custom made orthotics, cortisone injections, some meds and last resort is surgery.