Complimentary Transportation for All Post Operative Patients. On Site Surgeries.

• Comprehensive Care of Foot and Related Disorders
• Diabetic Foot Care
• Routine Foot Care Services
• Non-Surgical Treatment of Athletic Injuries
• Custom-Molded Orthotic Shoe Gear
• Diabetic Shoe Gear Program
• Foot Surgery
• Work Related Injuries
• Minor In-Office Surgical Procedures
• Ossa Tron Certified
• Reconstructive Foot Surgery

Information and Surgical Options for Toenail Problems

TOENAIL SURGERY
Toenail surgery is employed to alleviate the following types of deformities.
• Ingrowing Toenail
• Incurvated Nail
• Fungus Nail
• Thick Nail (Hypertrophied)
• Injury to a Toenail

INGROWN TOENAIL AND INCURVATED NAIL
This is a condition in which a portion of nail presses into the flesh, causing pain, redness and sometimes infection. If this condition is left untreated, an exaggerated swelling of the skin along the nail border, known as proud flesh, can form.

TREATMENT
Ingrown toenail surgery is usually per formed under local anesthesia or with topi cal anesthetic agents. Preoperative X-rays may be taken to be sure there is no bone spur present or infection of the bone when the condition is of chronic duration. Re moval of a portion of the nail border caus ing the problem will give temporary relief. Permanent correction to remove the offend ing portion of nail and nail root could be required if this is a recurring problem.

SUBUNGUAL EXOSTOSIS (Bone Spur Under the Nail)
Sometimes deformed nails are associated with a small bone spur at the tip of the toe under the nail. This can cause considerable discomfort at the nail or beneath it. The skin between the nail and the bone can become irritated and result in a painful corn or cal lus. If the nail is removed, without remov ing the bone spur, the corn or callus can continue to form on the tip of the toe. There fore the most effective way to treat this con dition is to also remove the spur.

THICKENED DEFORMITY OF TOENAILS
This condition can stem from a nail fungus, nail injury or it may be inherited. Sometimes other diagnostic tests, such as a nail culture, could be required. Fungus nails can often be treated with the new oral antifungal agents. When pain persists or conservative measures fail to give adequate relief of pain, treatment may require removal of the nail and destruc­tion of the nail root.

LASER SURGERY
This involves the use of a special high fre quency laser. Fungus tissue and nail can be removed on a permanent basis when the nail root or growth center is destroyed with a laser.

CHEMICAL CAUTERIZATION FOR PERMANENT NAIL REMOVAL
This procedure involves the permanent removal of one or both sides of a toenail and the removal of fungus tissue if it is present. The root of the toenail is then treated with a chemical agent that destroys it. If the entire toenail needs removed, the same procedure is employed for the entire tissue under the nail and the complete root.

CONCLUSION
There are additional methods of treatment for this common foot problem to consider. This includes oral and/or topical medication for toenail fungus, especially if surgical cor rection is not desired or possible due to medical circumstances.

Information and Surgical Options for Toe Deformities

DIGITAL/TOE DEFORMITIES
A deformed toe is one of the more common conditions known to afflict the foot, whether it be a hammertoe, mallet toe or overlap ping toe.

HAMMERTOES
A hammertoe is a flexible or rigid contrac tion usually affecting the second, third, fourth or fifth toes. Most often a biome-chanical abnormality results in the larger muscles of the foot and leg overpowering the smaller intrinsic muscles of the foot. Muscle imbalance leads to a bending or “buckling” of the toe joints. These buckled or contracted positions create any number of problems within and on top of the toe deformity. One or more small joints become prominent on top of the malpositioned toe. Tendons, ligaments and joint capsules in that area have a greater chance of tightening and shortening. Shoe irritation of the deformed digit results.in corns, skin inflammation and inability to wear shoes comfortably. If left untreated, these conditions can progress to ulcers or infections.
A flexible hammertoe refers to a reducible hammertoe in contrast to the rigid hammer toe where the deformity is fixed or not easily straightened. There are many causes of ham-mertoes. Some are congenital, hereditary or acquired. An inherited condition may mean an inherited muscle imbalance around the toe or a parent with an abnormally long toe. An acquired hammertoe refers to those caused by short stockings or short/pointed shoes, espe cially where a long toe is present. Arthritic patients and those with diabetic neuropathy can be more susceptible to hammertoes.

MALLET TOE
A mallet toe is similar to a hammertoe, except the deformity occurs closer to the end of the toe.

Mallet Toe OVERLAPPING TOE
An overlapping toe is one that is malpositioned from birth or acquired over time. It often produces some abnormality in the tendon, ligaments or skin, many times producing painful corns.
All of the toe deformities mentioned can lead to other positional deformities, enlarge ment of bone tissue or bone spurs. Shoes further aggravate these conditions and can cause additional pain, inflammation and corns.

Overlapping Toe CORNS
The body`s response to excessive amounts of pressure against the skin manifests itself by forming thick, hardened skin or corns. Corns are most often the result of an en larged bone or bone spur pinching the skin against a shoe. A corn can be indicative of a pressure point between the toes.
Soft corns refer to corns that exist between the toes. They are the result of two bones rubbing against each other, pinching the skin. Sometimes more than one soft corn will form.

TREATMENT
Conservative treatment can consist of one or more of the following.
1. Trimming, digital splinting and/or pad ding of the corn.
2. Orthotics or inserts in shoes to correct improper walking.
3. Injections to relieve pain and inflamma tion.
4. Larger or extra depth shoes to accommo date toe deformities.
If these conservative methods are unsuc cessful in treating your deformity, then cor rective toe surgery should be considered.
The surgical correction of your toe defor mity may be performed in the office, out patient surgical center or as one-day hospi tal surgery.

DIGITAL/TOE SURGICAL OPTIONS
These procedures help to straighten the toes by cutting the bone, tendon, joints and/or ligaments.

1. TENOTOMY AND CAPSULOTOMY
The terms tenotomy and capsulotomy refer to the cutting of tendons and joint capsules. More specifically in relation to hammertoe deformities, the tight tendons and joint cap sules located on the top and bottom of the buckled or contracted toe joints are released. 
Once these tight, soft-tissue structures are cut and relaxed, the toe can resume its nor mal flattened posture.
2. ARTHROPLASTY
This very popular procedure involves re moval of cartilage and bone in remodeling a deformed joint. It allows for relief of the painful area.
3. ARTHROPLASTY WITH FIXATION FOR FUSION
This procedure involves joint removal and the use of a wire (pin) to stabilize or fuse the deformed toe. 
4. ARTHROPLASTY WITH TENDON RELOCATION
A joint space is created and the toe is re aligned by relocating the flexor tendon, which pulls the toe down.
5. ARTHROPLASTY WITH IMPLANTATION
Following excision of a joint, a plastic im plant is placed inside to act as a functional spacer.
6. DEROTATION/ REALIGNMENT PROCEDURE FOR OVERLAPPING TOE
A wedge of skin and a segment of bone are removed to realign the overlapping toe.
7. BONE SPUR REMOVAL
An incision is made and an instrument is used to file or excise the bone spur and re move the source of increased pressure.
8. OSTEOTOMY
A cut is made through the bone to allow it to be realigned. Wire or pin fixation could be required.
POSTOPERATIVE CARE
After surgery, you will receive instructions regarding the care of your dressings, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling.

CONCLUSION
Painful toe deformities prevent patients from being able to wear shoes comfortably and perform their normal activities.

 

Information and Treatment Options for Heel Spur Syndrome and Plantar Fasciitis

HEEL SPUR SYNDROME PLANTAR FASCIITIS
The heel bone or calcaneus is the largest bone in the foot and projects backward beyond the leg bones to provide a useful lever for the muscles of the calf. It bears all of the body`s weight with each step. The stress placed on the heel bone and its associated structures is tremendous and makes it susceptible to what is known as plantar fasciitis or heel spur syndrome. The pain that results from these disorders is caused by the inflammation at the interface of the plantar fascia and heel bone. The plantar fascia constitutes the long band of fibers attached at the bottom of the heel bone and extend to where the toes begin. It also helps create the arch of the foot.
Plantar fasciitis and heel spur syndrome are usually the result of biomechanical faults. Biomechanical faults refer to such abnormalities as flexible flat feet, high-arched foot deformities and a tight Achilles tendon. These disorders place a greater amount of stress on the plantar fascia.
Other causes of stress on the heel and plantar fascia include recent weight gain, high-impact athletic activities, prolonged standing or walking, trauma, lower back problems and arthritis. Pain could also
be stemming from a microtraumatic fracture of the heel, causing a heel spur as a result of this injury.

TREATMENT
A heel spur may or may not be present on an X-ray. Not all heel spurs hurt. It is the inflammation of the plantar fascia that causes the pain. Treatment is directed at reducing stress on the plantar fascia and decreasing inflammation at the attachment of the plantar fascia. It usually involves rest, heel cups, stretching, physical therapy modalities, strapping, orthotics, steroidal injections and non-steroidal, anti-inflammatory medications.
In a minority of cases when the above conserva tive measures fail to give relief, surgical intervention becomes necessary .The plantar fascia is released in part from its origin. When a large spur is present, reduction or removal could become necessary. Advances in surgical technology now permit plantar fascial release via the endoscope. This procedure is known as Endoscopic Plantar Fascial release or EPF. Extracorporeal Shockwave Therapy is also a new modality that is available.

PREOPERATIVE CONSIDERATIONS
Preoperative considerations are assessed by your doctor and include your age, occupation, physical activities or limitations and general health status. Surgery can be performed in the office, outpatient surgical center or as one-day hospital surgery.

POSTOPERATIVE CARE
After surgery, you will receive instructions regarding the care of your dressings, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling.
An orthotic could be recommended to control the abnormal bio mechanical forces and thus prevent recurrence of the symptoms.

X-rays

Help to diagnose foot pathologies and choose an appropriate procedure

Dopplers

Checks the vascular status of the patient

MRI

Magnetic Resonance Imaging could be done in the office to specify diagnosis

Orthotics

Custom made shoe inserts are provided for the patients with various deformities

A Treatment for Foot and Leg Dysfunction and Pain Why Do I Need Orthotics? 
Your podiatrist has recommended the use of a foot orthotic to control, relieve or treat your foot disorder. These devices may relieve pain or prevent the return of painful foot symptoms through control of foot function and mechanics. No doubt you have questions about orthotics, and hopefully this brochure will help to answer your questions.
Normally, the best orthotics are custom-made and specifically crafted to meet the needs of a particular patient. They may be combined with other forms of treatment such as injections, medications, physical therapy or surgery. Therefore they are an important component in the treatment and prevention of many foot disorders.

Laboratory Fabricated Orthotics 
Orthotics are custom-fabricated shoe inserts manufactured from many types of materials such as plastic, polypropylene and graphite. They are worn on a full-time basis to control the way in which your foot functions as you walk. There are many kinds of orthotic devices, prescribed specific to your activity level, foot problems and other health factors. From walking to running, aerobics to basketball, orthotics can help you continue to enjoy your favorite activities.
Functional foot orthotics are made from neutral position plaster or fiberglass castings, foam trays or 3-D foot scanned images provided by machines like the TOM-CAT foot scanning system (pictured). The practitioner sends these along with the clinical information to an orthotics laboratory, such as SOLO Laboratories Inc., where a technician reviews the cast or image and the prescription. Some labs like SOLO use computer-aided-design/computer-aided-manufacturing programs (known as CAD-CAM) to scan your foot impressions from the cast or foam tray for the best possible fit.
After the order and image are approved for production, a technical specialist takes responsibility for the fabrication and the quality control of the individual prescription. The custom fabricated orthotics are sent to the prescribing doctor to dispense with instructions for the patient.

Types of Orthotics 
Because we are born with different foot structures, and because we engage in different occupations and activities, there are specific grades of orthotics for individual patients. Orthotics can be used for children, adults, athletes, elderly patients and often patients following surgery. Orthotics can be categorized into three general groups—rigid, semi-rigid or soft/flexible—each with a specific purpose to either alter foot function or accommodate foot deformity.

Rigid Orthotics
Rigid orthotics offer maximum functional control, especially in regulating foot motion during the gait cycle. They are often made from plastic or different grades of polypropyl ene and are perfectly suited for the growing child in which stabilization of gait, support and proper growth alignment maintenance is important. Rigid orthotics are often used to treat foot and leg pain, leg length differences and abnormal foot function.

Semi-Rigid Orthotics 
Semi-rigid orthotics combine foot protection with leg and foot function control. Often used as a sports orthotic to control operation of the foot during athletic performance, these orthotics can also protect the athlete from stress-related sports injuries. A combination of different materials, allowing for function control and shock absorption, is used to fabricate these orthotics for different sports such as golf, tennis, basketball, baseball, football, jogging, aerobics, skiing, etc.

Soft/Flexible Orthotics 
Soft/Flexible orthotics maximize shock absorption for the patient who may have lost the normal fat-pad cushioning of the foot. Since this condition produces painful pressure areas, soft/flexible orthotics are used as a replacement for the body`s fat-pad. These devices are made with leather and softer plastic materials to provide off-loading and cushioning. They are helpful for diabetics, arthritics, and patients with severely deformed feet and are strongly recommended for the geriatric patient.

Durability and Longevity 
Orthotics usually require a gradual break-in period of two to four weeks. You may become a daily orthotic wearer depending on your problem or diagnosis and how your foot responds to orthotic control. Sometimes patients need one pair for work and another for recreation. Women who wear different heel heights could require an additional pair.
Orthotics have a variable life span subject to your activity level. Generally, most require periodic repair and/or refurbishing over time. Taking care of your orthotics by replacing torn or badly worn covers or broken posts (additions put on the orthotics) can extend the life of the devices. If the orthotics crack, lose shape or start rocking in your shoes, then it is time to revisit your podiatrist because the devices will not function correctly.

Shoes and Orthotics
When purchasing new shoes, try them on with your orthotics.
The style should conform to the orthotics for a comfortable fit.
Each time you purchase shoes, they will need to be checked for
comfort level and fit with your orthotics. You can`t assume the orthotics will fit correctly in all shoes because shoe sizes vary from manufacturer to manufacturer.
Your evaluation for orthotics by a podiatrist will include a complete biomechanical exam. This exam evaluates your
specific gait pattern and joint motion involving your lower extremity. Your foot type, muscle strength, age, activity level and shoe gear will also be evaluated in order to properly prescribe your foot orthotics.

Fluoroscopy

Diagnostic modality for evaluations of the  range of motions

Bunions

Information and Surgical Options for Bunions and Bunionettes

SOME FACTS YOU SHOULD KNOW ABOUT BUNIONS
A large percentage of the population is likely to develop a bunion. Both men and women can develop bunions, although it appears that bunions are more commonly seen on women`s feet. A bunion is a swelling or enlargement of the large toe joint on the inner side of the foot. The deformity usually develops gradually and will cause pain from shoes rubbing against the enlarged bone. There may be swelling, redness and deep aching pain associated with the bunion joint, causing a bursitis.

WHY DO BUNIONS DEVELOP?
Bunions develop from a weakness in the bone structure of your foot. There is a strong possibility that heredity is the underlying cause. As a result, the joints have a tendency to move out of proper alignment given the instability of the bones and ligaments that form the various joints and arches in your feet. The bunions are not caused by improper shoegear but are significantly aggravated by improperly fitting shoes that place an unusual degree of pressure at the bunion joint.
As bunions become more severe, the joint moves out of proper alignment and eventually arthritis damages the joint space. The large toe will move sideways towards the second toe, and the foot tends to widen across the metatarsal area. This is a mechanical consequence not usually caused by shoegear. However, shoegear can certainly aggravate the condition and speed up the development of a more serious and significant deformity.

If surgery is recommended, we will discuss the surgical procedures that are best suited for your particular bun ion deformity. There are many different types of bunion surgical procedures now available, many having been developed by podiatrists specializing in this type of surgery. The procedure selected is based on examination, X-ray findings, age and activity level of the patient; factors that can influence the final outcome. In all cases, both doctor and patient need to work as a team for a successful and satisfactory result.

WHAT KIND OF SURGERY IS REQUIRED TO REPAIR MY BUNION?
Mild bunion deformities that require surgery usually are treated by removing a small portion of the enlarged bone at the head of the metatarsal. We may also lengthen the tendons around the joint to realign the big toe. In more severe bunion deformities, your podiatrist may choose to perform several different procedures to realign the meta tarsal. In some cases, pins, stainless steel screws, staples, wires or artificial joint implants are used so that realignment of the joint is maintained while the bone is healing.

TAILOR`S BUNION DEFORMITY 
A tailor`s bunion is a small bunion at the base of the little toe. This condition is also known as a Bunionette. The name Tailor`s Bunion was derived from the way tailors used to sit with their legs crossed as they worked. Crossing their legs put pressure on the area known as the fifth metatarsal head, subsequently resulting in pain.
There are a few conditions which may cause the “bump” in this area:
1. An overgrowth or swelling of the soft tissue covering this joint (bursitis).
2. A congenitally (at birth) wide head of the fifth metatarsal bone.
3. An actual bowing and/or splaying of the fifth metatarsal bone.

HOW ARE TAILOR`S BUNIONS TREATED?
Where the bone is splayed, the surgery will consist of cutting through the bone or cutting out a wedge of bone to improve its position. These procedures are known as osteotomies, corrective surgical fractures of the bone.

SUMMARY
Remarkable advances have been achieved in the past several decades with instrumen­tation and technology to improve medical and surgical procedures.
Many of the surgical procedures described in this brochure can be performed in an out-patient setting. Remember both you and your doctor are a team working toward a common goal – comfortable feet – so that you can remain active in today`s fast-paced world. Do not hesitate to ask us any questions you may have concerning your bunion problem or the various treatments recommended to you.