Conditions & Treatments

On this page, you'll find detailed information on the conditions I treat with recommended procedures and treatments.

CONDITIONS

Ankle Arthritis

The ankle is the most commonly injured part of the body, and even one severe ankle sprain can accelerate the onset of severe ankle arthritis. The ligaments on the outside of the ankle are the most commonly injured ligaments of the ankle.  The stress to these ligaments from an ankle sprain can forcefully elongate and distort the ligaments altering their elastic ability to stabilize the ankle.  Chronic instability can accelerate cartilage damage (arthritis) and make every step painful.  High impact injuries with or without fractures can also lead to early ankle arthritis.  Poor foot alignment (high arch or flatfoot) can place increased stress back into the ankle joint.  Other fusions of the foot (rearfoot, midfoot, and forefoot) can also place an excess amount of stress upon the ankle.  Of course any type of systemic arthritis can also afflict the ankle.    

Treatment options: 

Amniotic or steroid injections.  Rx Bracing, ankle arthroscopy, cartilage grafting, fusion, or Total Ankle Joint Replacement. 

The ankle is the most commonly injured part of the body, and even one severe ankle sprain can accelerate the onset of severe ankle arthritis. The ligaments on the outside of the ankle are the most commonly injured ligaments of the ankle. The stress to these ligaments from an ankle sprain can forcefully elongate and distort the ligaments altering their elastic ability to stabilize the ankle.  With continued unprotected ambulation the unstable ankle generates more inflammation that can permanently settle into the joint creating long-term pain (ankle joint synovitis and impingement lesions).  Chronic instability can accelerate cartilage damage (arthritis) and make every step painful. 

 

Treatment Options:

 

The most important part of acute care is ice and functional immobilization with lace-up-figure-of-8 brace.  The worst thing for a new ankle sprain is another ankle sprain.  

This is an angular joint deformity of the great toe joint creating instability and excess stress to the joint leading to development of pain and arthritis.  Bunion refers to the red, swollen, radish-like bump that develops behind the great toe.  The most common mechanical cause is flexible pronation.  Pronation is the lengthening and collapsing of any arch (high or low) transitioning the foot into an unstable platform.  This instability creates excess stress and force in the foot joints and accelerates arthritis and joint deformities.  This is why we are only as strong as our foundation, and this unstable/pronating foot can be the cause of ankle, knee, hip, and back pain. 

 

Treatment Options: Orthotics, Shoes, Therapy, Surgery

I have found that most people think they have a flatfoot, while in reality they have a flexible foot that lengthens and pronates while still maintaining a flexible arch.  A true flatfoot collapses entirely, flesh to floor.  One good indicator is a wet footprint that reveals no arch. 

 

Treatment Options:

 

The single most important thing about a flat foot is flexibility. If it is flexible then the joints

are intact and correction or control is more achievable. Treating a flatfoot early is the best course of prevention. This can be handled in many different ways: orthotics, braces, or surgery. I approach flat foot surgery by preserving as many joints as possible. One great surgical resource (when appropriate) is the subtalar joint implant.

Great Toe Arthritis

This can develop without an angular deformity change (bunion), but can create similar debilitating pain.There are different stages and causes of arthritis (trauma, overuse, pronation, genetics) but severe arthritis typically involves replacing vs. reconstructing or fusing the joint.

 

Treatment Options:

 

Arthrosurface Joint Replacement is the only system that allows immediate weight-bearing recovery due to the robust screw implantation design.

Hammertoe

This is a painful joint contracture (rigid or flexible) of the joints within the toe occuring with both flat feet and high arch feet due to different mechanics.

 

 

Treatment Options:

 

Options are limited to shoes, orthotics, and padding. Only surgery will reverse/resolve.

 

Second Toe Joint Deformity/Pain Due To Ligament Rupture

This condition stems from overuse or traumatic injury causing the ligament (plantar plate) on the bottom of the joint to tear/rupture.  As the ligament tears there is pain, swelling and elevation of the toe.  this most commonly occurs with the second toe.  This is different than hammertoe or turf toe.

 

Treatment Options:

 

Repair the ruptured ligament is the only way to fix, preserve the joint. For more information, click here.

 

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Procedures & Techniques

Ankle Arthroscopy

This is an underutilized procedure helpful for resolving a large host of ankle joint related problems.  Most chronic ankle injuries are the end result of an undertreated ankle sprain.  Arthroscopy can be a simple approach to removing extensive scar tissue, inflammatory tissue, loose bone, fractured bone or bone spurs.   It can also help repair damaged cartilage or ligaments.

Cartilage Replacement Grafts

This is available for the ankle joint (and rarely the great toe joint) primarily.  This is limited to a partial (max 2-inch) cartilage defect repair. This utilizes a cadaver graft plug consisting of both cartilage and bone. This is placed via an open surgical procedure. View video.

Flatfoot Reconstruction

My approach to flatfoot surgery is to preserve as many joints as possible, when possible.  Flatfoot surgery focuses on stabilizing the tripod of the foot (great toe joint, pinky toe joint and heel).  Most commonly this requires surgery involving the achilles tendon, heel bone, and midfoot joints.  Some cases require multiple tendon and multiple bone/joint procedures.  This is highly variable per patient presentation.  It is never too early or late to be evaluated, and often better not to wait for pain or disability.

Functional Fracture Management

This means repairing bone fractures, tendon ruptures, and ligament tears with small incisions, low profile-precontured plates, buried screw systems, external fixators, and high tech bone and tissue biologics.  The importance of this approach is to facilitate early weightbearing recovery and reduce postoperative complications.  Less is more, keep it simple approach. 

Non-surgical Injection Treatments

The best option today is umbilical cord injections for chronic joint or soft tissue injury including plantar fasciitis, tendinitis, and arthritis.  More info.

Umbilical cord tissue includes both amniotic-placental tissue and umbilical cord.  This tissue is a readily accessible product (every child birth).  This tissue is abundant with regenerative properties and biologic factors to promote healing by reducing inflammation and scar tissue, as well as assisting your body create healthy new tissue/bone/cartilage.  Refer to links for more information.  Typical injection cost is $700.00 (out of pocket, not covered by insurance) and can be done in an office setting.  

Great Toe Joint Replacement

Arthrosurface Joint Replacement is the only system that allows immediate weight-bearing recovery due to the robust screw implantation design. 

RX Braces & Orthotics

One true difference between a Podiatric Foot and Ankle Surgeon vs an Orthopedist is bracing and orthotics. This stems from the true foundation of Podiatry: Biomechanics.  I believe better surgical outcomes start with better planning and this can only happen with a strong knowledge-base of lower extremity biomechanics.  When surgery is not the answer for whatever reason, bracing and orthotics are a great alternative/adjunct when applicable.  

 

I offer bracing solutions for foot and ankle deformities (post-traumatic and post-stroke) and weaknesses (drop foot and tendon ruptures).  I am the only DPM in the area creating Richie and Arizona braces.  I am also a certified Sole Support orthotic designer, and my Rx orthotics are guaranteed. 

 

Why my orthotics are different? Orthotics are better known as arch supports.  Arch supports only work by filling/touching your arch.  A true Rx orthotic should contact the contour of your arch and push your arch into a more supportive (neutral) position. 

Total Ankle Replacements

In the past decade, there has been a revolution of Total Ankle Replacement designs transforming the procedure into a more acceptable, more effective, more reliable and safer option.  In the next 10 years, Total Ankle Replacement will become as popular as hip and knee replacement surgery.  The most reliable, both in operative installation and patient function, are the Wright Medical Total Ankle.

 

The recovery for this procedure is fairly dynamic with partial (crutch assisted) weight bearing beginning immediately.  Most patients stay overnight after surgery to assure pain management is satisfactory.  Full weightbearing without crutches, in regular shoegear can begin as early as 4 weeks.  Physical therapy will be necessary to assist with swelling, strength and balance training.  Most patients take 6-12 months to return to full activity.  

Life after TAR will be without racquet or high impact sport/activities.  Running short distances, low impact, forefoot-style running is recommended and possible in some cases.  Ideally low impact activities are best to preserve the implant as long as possible.  As with most implants there is a 10 year timeline in which upgrades or changes may need to occur. 

The greatest challenges with TAR, in comparison to hip and knee replacements, is the strict criteria in regards to body weight (250), overall health, age, and foot structure.  TAR can only be placed above a stable foot.  Often times there are structural foot procedures that need to be done before TAR install. (See flatfoot reconstruction). 

Nerve Surgery/Pain Management

I am a member of the Association of Extremity Nerve Surgeons offering advanced care for common, challenging nerve conditions of the lower extremity.

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