Posts for: July, 2018
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