Podiatric Medicine and Surgery
Limb salvage is an area of expertise which aims to reconstruct a functional limb via various orthopedic procedures while removing all non-viable and infectious tissue as an alternative to amputation. Two of the common risk factors that places an individual at risk from loosing a limb is Peripheral Arterial Disease and Diabetes.
Peripheral arterial disease, or P.A.D., develops when your arteries become clogged with plaque—fatty deposits that limit blood flow to your legs. Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack, stroke or loosing a limb. Plaque buildup in the legs does not always cause symptoms, so many people can have P.A.D. and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause. In all, P.A.D. affects 8 to 12 million people in the United States, especially those over 50.
According to the American Diabetes Association, more than 30 million Americans are diagnosed with Diabetes and more than 88 million Americans are pre-diabetic. Diabetes places an individual at significantly higher risk of loosing a limb than individuals without Diabetes.
Diabetic Foot Ulcers, or D.F.Us, development among the Diabetic population can be as high as 25%. Almost all individuals with DFUs have underlying P.A.D. and associated with high risk of lower extremity amputations.
Our Podiatrist along with Vascular doctors provide a multidisciplinary approach in diagnosing, treatment, management and prevention of the following:
- Diabetic Foot Care
- Diabetic Foot Ulcer
- Peripheral Arterial Disease
- Peripheral Venous Disease
- Wounds or Ulcers
- Diabetic Neuropathy
Sports injuries are very common in the foot and ankle and can be quite debilitating if they are undiagnosed or inaccurately treated.
Abrupt pain and functional limitations may be clear signs of injury, necessitating medical attention. Other times, injuries can be subtle and can worsen over time without the right treatment plan.
For athletes, quick return to full function as well as risk management of future injuries is paramount when treating patients.
Some of the most common sports injuries seen are ankle sprains, which are especially common among runners as well as athletes who play sports that involve twisting, jumping, and sudden changes of direction, including soccer, basketball, and tennis. A sprain is an injury to one or more of the ligaments supporting your ankle joint, and often occurs when the foot rolls inward or outward while performing activity.
Timely, accurate diagnosing of an ankle sprain is very important. Our podiatric surgeons conduct a thorough physical exam of your injured ankle and may recommend further studies, possibly including X-rays, ultrasound, CT scans, or MRIs to rule out a fracture, identify specific soft-tissue injuries, and provide a thorough explanation of your condition.
Treatment often consists of immobilization, physical therapy to strengthen muscles/enhance proprioception, as well as control pain and inflammation.
In severe cases, surgical repair of torn ligaments may be necessary.
Tendon and Ligament Injuries
Gradual wear and tear, overuse, high impact sports or even traumatic injury could lead to strains or even rupture of tendons to the foot and ankle. Tendons, along with ligaments, provide stability and dynamic support. Once these structures are damaged, our quality of life and physical activity decreases dramatically. Conservative treatment options can still be exhausted and many times when used appropriately can lead to full recovery. Surgical intervention may be necessary if conservative treatment fails.
Achilles Tendon Pain
Your Achilles tendon is the largest tendon in your body and as such, you rely on your Achilles tendons for a lot.
The Achilles tendon facilitates walking by helping to raise the heel off the ground. When you play soccer, basketball, or tennis, your Achilles tendons allow you to quickly change direction, slow down, or speed up.
Your Achilles tendons are durable and can absorb the shock of running and jumping. Still, because you use them a lot, including in high-impact exercise, they’re prone to injury. Usually, you injure your Achilles tendons when you go past your physical limits or perform activities you’re not used to.
One of the most common injuries to the tendon is Achilles tendinitis, an overuse injury that causes chronic inflammation. It’s common among distance runners and middle-aged people who only play sports on weekends. You can be at a higher risk for injury if you suddenly increase the duration or intensity of your workouts, don’t stretch or warm up or run on even surfaces. Certain foot structures are also at higher risk especially flat feet.
In addition to overuse injuries, you can suddenly injure your Achilles tendon, including tears and ruptures.
Chronic achilles tendon injuries often present as pain and stiffness in your calf and back of your heel. Stiffness is usually worse in the morning and may improve with activity.
Sudden ruptures will be quite painful and you may have felt or even heard a pop at the time of injury.
Be sure to make an appointment for evaluation if you have concerning heel pain.
Accurate diagnosis using x-ray, ultrasound and even MRI is paramount in choosing the right treatment plan for your achilles pain or injury.
Chronic achilles pain or injury is often treated effectively with rest and physical therapy. If this treatment is ineffective, your podiatric surgeon may recommend surgical intervention for ultimate relief.
Ankle fractures and Foot fractures are common as well in high impact sports and traumatic events. Our podiatric surgeons are highly trained in the management of fracture care.
When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This digging in of the nail irritates the skin, often creating pain, redness, swelling and warmth in the toe.
If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe is not painful, red, swollen or warm, a nail that curves downward into the skin can progress to an infection.
Initial treatment can sometimes be performed at home, however home treatment is strongly discouraged if an infection is suspected or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot or poor circulation.
Usually, it is recommended to be evaluated by our podiatrists for recommendations and treatment.
After examining the toe, the podiatric surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.
Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail.
There can be many different causes of heel pain although most commonly it is caused by plantar fasciitis. You may have been told you have a heel spur, which is sometimes present in someone with plantar fasciitis.
Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or, rarely, a cyst.
It is best to be evaluated by one of our foot and ankle doctors who can accurately diagnose the source of your heel pain.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.
Most common causes of plantar fasciitis relate to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity and overuse may also contribute to plantar fasciitis.
About 9/10 patient’s achieve complete symptom relieve with non-surgical treatment. This treatment is comprised of physical therapy/stretching exercises, lifestyle modifications, shoe gear modifications, custom orthotic devices, night splints and local steroid injections as needed.
Although most patients with plantar fasciitis respond to nonsurgical treatment, a small percentage of patients may require surgery due to continued symptoms after months of conservative therapy. Your podiatric surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
Neuromas occur in the foot when the nerve tissue leading up to your toes grows or thickens excessively.
Symptoms include pain and swelling in your forefoot and in-between toes, tingling or numbness in the ball of your foot and pain when you put weight on the ball of your foot.
The best way to diagnose a neuroma is a thorough evaluation by one of our foot and ankle doctors.
Neuromas don’t go away on their own so it is important to accurately diagnose and treat in a timely manner.
Treatment ranges from custom orthotics to local injections, to surgical removal if all else fails.
It is important to start treatment at the first sign of symptoms to avoid surgical intervention.
Foot and Ankle Arthritis
There are many different types of arthritis that occur in the body. When it comes to the foot and ankle, it is often caused by osteoarthritis or “wear-and-tear” arthritis. Other common causes are rheumatoid arthritis and post-traumatic arthritis.
Osteoarthritis, commonly referred to as degenerative joint disease affects almost 30 million Americans. It is common in the foot and ankle and is a chronic condition in which the cartilage in joints break down over time, causing pain and inhibiting the joint’s ability to move. The joints commonly affected are the big toe joint, the midfoot as well as the ankle.
Rheumatoid arthritis is an autoimmune disease that causes your body to mistakenly attack your joints in the same way it would fight off an infection. This causes joint inflammation and inhibits motion. If not treated, this inflammation will eventually break down the cartilage in the joint causing worsening pain and further restriction in motion.
Non-surgical treatment often consist of anti-inflammatory oral medications, orthotic devices/bracing to restrict motion, and steroid joint injections.
If non-surgical treatment is not effective, it is best to discuss surgical treatment options with your podiatric surgeon.
A bunion is a painful, bony bump that forms on the joint at the base of your big toe. The area around the bump may be painful, swollen, or red, and these symptoms get worse when there’s something pressing against the bump, like ill-fitting shoe gear.
You may find bunions unsightly, but they’re more than just a cosmetic problem. Eventually, bunions can change the alignment and structure of your foot, so be sure to schedule an appointment with our foot and ankle doctors if you have one, even if it’s only causing minor discomfort. Because bunions are progressive, they do not go away and will usually get worse over time. But not all cases are alike—some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited but certain foot types that make a person prone to developing a bunion.
Although wearing shoes that crowd the toes will not actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.
A mild bunion deformity can often be managed by shoe gear modification, padding, and custom orthotics.
If nonsurgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it is time to discuss surgical options with one of our podiatric surgeons.
A variety of surgical procedures are available to treat bunions. The procedures are designed to remove the bump of bone, correct the changes in the bony structure of the foot and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain and deformity. Together, you and your surgeon will choose which procedure best works for you.