Posts for category: Foot Surgery
It is normal to have anxiety and concerns about potential foot surgery. I would like to ease this anxiety and provide a summary of common foot surgeries that our practice can offer if conservative treatment does not relieve your foot pain. Many changes have made over the past 10-15 years to make foot surgery more tolerable with a quicker recovery time.
Surgical techniques have improved considerably in the last ten years. Advances in foot surgery allow for a quicker recovery and more reliable results. The most common foot surgeries that our practice offers include foot conditions such as bunions, hammer toes, neuromas and chronic plantar fasciitis. Our foot surgeons keep up with the latest surgical techniques and stay current yearly with surgical courses around the country.
Our practice exhausts all conservative treatment before considering foot surgery. Most foot conditions fortunately can be treated with conservative treatment. You should understand that there is never any guarantees with any surgical procedure. Our foot specialists are both board certified in foot surgery and take great care and lengths to follow our patients closley from the preoperative to the end of the postoperative period. We want to be able to have our patient's get back to their own specific chosen activity after surgery with less pain and increased function.
These deformities are most commonly an inherited trait. Tight toe box shoe gear and high heel shoes can increase swelling around the bunion deformity and place pressure on the hammer toe prominence. Excessive flattening of the arch can contribute and increase the size of a bunion over time and make hammer toes more contracted. Conservative treatment consist of wider toe box shoes, bunion cushions, custom orthotics, hammer toe splints/gel sleeves and various padding. I do not recommend surgery for this condition unless conservative treatment has not alleviated pain and discomfort.
Surgical correction of a bunion typically involves cutting and repostioning the first metatarsal. This bone cut in the first metatarsal is fixated either with screws or a wire. Recovery from bunion surgery involves weightbearing in a walking boot for 6-8 weeks with a goal to return to sneakers about the 7 week mark. For more severe bunion deformities a different bone cut and placement may be required. This would involve a period of Non-weight bearing for at least two weeks. A low impact exercise program is typically recommended 6-8 weeks after surgery. The use of screws and in some cases plates over the past several years allows patient to become more mobile sooner without the need for extended time off the foot.
Surgical correction of hammer toes has advanced over the past 10 years. The advent of internal implants to keep the digits in a straight position rarely have to be removed and do not involve having an external wire that protrudes out of the digit. The surgery involves fusing the digit at the knuckle area (PIP) joint with either a K-wire or internal hammer toe implant. K-wires are used for more severely contracted hammer toes and are removed at 4-6 weeks in the office setting.
A neuroma is an inflammation of a digital branch that runs in between the third and four digits on the ball of the foot. Symptoms typically involve pain, burning, and shooting pain form the ball of the foot extending into the third and fourth digits. Less commonly is a 2nd web space neuroma with the same symptoms into the 2nd and 3rd digits. The culprit typically is reduction of fat padding on the ball of the foot as one ages, high heel shoes, and increased loads to the plantar forefoot. Conservative treatment consist of offloading padding, custom orthotics, change in shoe gear, oral NSAIDS, cortisone injections, and alcohol sclerosing agent injections. The advent of alcohol sclerosing agent injection has decreased the amounts of elective surgery for neuroma excisions in our practice over the past 10 years. The injection essentially causes degeneration fo the nerve fibers which results in decreased pain and discomfort.
Neuroma surgery involves removal of the digital braches to the third and fourth digits through either a dorsal or plantar incision. The surgery is an outpatient surgery and patient will be weight bearing in a surgical shoe for three to four weeks after surgery. Return to sneakers usually is about four weeks after surgery. Return to low impact exercise is usually after four weeks after surgery.
Plantar Fasciitis/Achilles tendonitis
Plantar fasciitis and achilles tendonitis are the most common heel pain complaints that we treat in our office. 90% of patients will have complete resolution of heel pain with conservative treatment. These conditions are usually an overuse injury from increased loads to the plantar fascia and achilles tendon over time. Conservative treatment involves icing, oral NSAIDS, cortisone injections, physical therapy, custom orthotics, stretching, and night splints.
Recalcitrant heel pain can sometimes lead to surgery. Our practice over the past 15 years utilizes a minimally invasive surgical procedure called Topaz. Topaz is an outpatient procedure under local and IV sedation. Needle holes are placed in a grid like fashion over maximal area of pain on the bottom or back of the heel. The Topaz unit is inserted into the needle holes and treated with short burst of electric enegry. Microscopic cutting of the fascia or tendon increases blood supply and break-up scar tissue. No sutures are needed and patient typically return into a sneaker within two weeks after surgery. The first two weeks patient wear a walking boot. Release of the plantar fascia ligament in the other options which we rarely have to perform and is only used for extreme cases of chronic heel pain.
In conclusion over the past 10-15 years our foot specialists at Carolina Foot Specialists have continued their passion of finding ways to minimize down time during foot surgery for our patients so that they can return to their chosen activity sooner and hopefully pain free.
The advent of newer internal fixation and less invasive bunion/hammer toe surgery, alcohol slcerosing agent injections for neuromas, and Topaz for various forms of heel pain have allowed our patient's to meet their specific goals if conservative treatment options have not relieved their specific foot pain.
For more information please refer to our website: carolinafootspecialists.net
We know how it feels to have an ingrown toenail and the anxiety that comes with it. We at Carolina Foot Specialists have ways to lessen your anxiety. Our technique is a painless procedure which involves application of ethyl Chloride that freezes the skin and administration of a local anesthetic. The procedure takes about 10-15 minutes in the office and is the most common procedure that our foot specialists perform. We see patients from the ages of 2 two 95 that suffer from this ailment. Typically most of our patients are back to normal activity within a few days. Options include a partial nail avulsion that allows the nail to grow back within 6 months or a permanent procedure that doesn't allow a small corner of the nail to grow back.
For more information please refer to our website at www.carolinafootspecialists.net
We would like to reference a great article on conservative treatment for Bunions. Also we have a nice video that we created on both the conservative and surgical treatment of bunion deformities. Dr. Saffer and Dr. Brown are both board certified foot surgeons but take an aggressive conservative approach to bunion deformities. Sometimes simple changes in shoe gear and activity can decrease symptoms.
If surgery is needed that Bunion surgery is one of the most common foot surgeries performed by our foot specialists. The procedure is typically outpatient surgery and takes less than an hour to perform. Our foot surgeons follow patients very closely during the postoperative time frame which takes about 6-8 weeks to heal. Most patients during that time can weight bear in either a walking boot or surgical shoe.
Please look below at one article and one video on conservative and surgical treatment options for bunion deformities.
One of the most common diagnosis that we see in our practice is ingrown toenails. Children often hide this foot problem from their parents because of fear of going to the doctor. We consider the treatment for ingrown toenails to be virtually painless and we understand the anxiety that children as well as adults have before they come to see us. Let's talk a little about what an ingrown toenail is and how we treat this common foot condition.
An ingrown toenail occurs when the nail curves sideways into the skin alongside the nail. This can cause pain, especially when wearing tight shoes. It can also lead to an infection with redness and swelling. Ingrown toenails can be caused from trimming your own nails too closely, trauma to the nail, a family history of ingrown toenails, and sometimes pedicures.
The side of the nail will need to be removed in order to stop the pain and release any infection present. If there is a lot of redness and swelling, then an antibotic may also be used. The redness and pain should begin to go away within 48 hours. It will take about two weeks for the exposed nail bed to become dry and all the swelling to go down.
If only the side of the nail was removed it will begin to grow back in a few months. To prevent recurrence, that side of the nail bed may be treated with a strong chemical to prevent the nail from regrowing.
We utilized techniques such as topical freezing spray so that most of the time you do not feel the injection. We have had much experience over the years easing anxiety before the procedure. We are able to correct the ingrown toenail the day of the office visit and follow you closely to make sure the healing process goes well.
What is a bunion?
A bunion is a “bump” on the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion—from the Latin "bunio," meaning enlargement—can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion".
Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This disruption can lead to instability in the joint and cause the deformity. Bunions are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk and our inherited foot type or our shoes.
Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.
Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.
Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.
The symptoms of a bunion include the following:
- Development of a firm bump on the outside edge of the foot, at the base of the big toe
- Redness, swelling, or pain at or near the MTP joint
- Corns or other irritations caused by the overlap of the first and second toes
- Restricted or painful motion of the big toe
What can you do for relief?
- Apply a commercial, non-medicated bunion pad around the bony prominence
- Wear shoes with a wide and deep toe box
- If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling
- Avoid high-heeled shoes over two inches tall
When to Visit a Foot Specialist
If pain persists, podiatric medical attention should be sought. Bunions tend to get larger and more painful if left untreated, making non-surgical treatment less of an option.
Diagnosis and Treatment
Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity.
We at Carolina Foot Specialists review with our patients detailed information regarding bunions during your visit. We will review your x-ray exam during your initial visit and outlined a conservative treatment plan to decrease your symptoms. Conservative tx options that we review are as follows:
Padding and Taping: Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.
Medication: Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammation caused by joint deformities.
Physical Therapy: Often used to provide relief of the inflammation and bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.
Orthotics: Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.
If pain continues despite conservative treatment options we will also discuss in detail surgical treatment options. Dr. Saffer and Dr. Brown are board certified in foot surgery and the most common reconstructive surgery that we do is Bunion surgery.
Surgical Options: When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available that we will discuss in detail. The goal of surgery will be to remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.
A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint. Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by our Foot Specialists.
There are some steps that may help prevent, or at least slow, the progression of bunions:
- Avoid shoes with a narrow toe box
- If your foot flattens excessively, make sure you wear supportive shoes, and if necessary, custom orthotics can be utilized.
- Please see our Foot Specialists at the first signs or symptoms of a bunion deformity, as early treatment may stop or slow its progression.
We have two locations in the Lowcountry. Dr. Brown is located at the West Ashley office and Dr. Saffer at the Mt. Pleasant location.