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With just a 10mm incision, the Beach-Bunionectomy is easier on your body meaning minimal pain and a faster recovery.
This innovative approach enables Dr. Lopez to correct your bunion confidently and quickly.
Making time for your medical appointments is hard, that is why we take care of you same day whenever possible.
After the Beach Bunionectomy is performed the incision is so tiny, no visible stitches are needed.
The Beach Bunionectomy has been loved and appreciated by the Miami community for years.
Less damage to your body means a smoother recovery, most patients can return to work the following day.
This innovative procedure performed by Dr. Ray Lopez can correct your bunion with a simple and quick minimally invasive approach.
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Bunions are those unsightly enlargements or bumps that occur on the inside areas of your feet. A bunion deformity can cause a wide range of problems for the patient and consequently can involve a varied approach to o treatment. An important point to consider in the understanding of this problem is that it is a progressive deformity. In other words, a bunion will in most cases worsen with time. No one can predict how fast the deformity will progress or to what extent it will cause debility or symptoms but most authorities would agree that sooner or later, it will worsen. Bunions, by nature, can cause pain in certain shoes, become a common site for arthritic changes, lead to secondary compensatory problems such as hammertoes or pain in the fat pad area. They may cause serious aesthetic or shoe wear concerns for certain individuals especially women who have to wear higher styled type shoes. Whatever the extent of involvement, a bunion deformity should warrant consideration by the patient and some level of professional evaluation by a foot specialist.
The possible causes of a bunion deformity are numerous and can only be numerically reduced pending a thorough examination by the foot specialist. Hereditary tendencies for bunions to occur in members of the same family, ranks high as a potential cause. Another frequent culprit is that of our manner of walking and in what type of shoe we wear over the bunion. In short, the particular mechanics of one’s walking style could be such that abnormal forces, pressures, and anatomical changes could result in a bunion deformity. Various arthritic conditions such as osteoarthritis, rheumatoid arthritis and gout can also lead to deformities of the first metatarsal joint and a bunion. An important fact to keep in mind is that. Generally speaking, shoe can aggravate an existing bunion deformity but will not initially cause one to occur.
INCISION - Large 1-2 inch incision on the top of the foot
PAIN - Pain for up to two months (varies on individual)
DECREASED RANGE OF MOTION - (of the big toe joint, 1st metatarsophalangeal joint) - Post-surgery, because of required dissection in this area when doing a traditional bunion surgery.
MOBILITY - Due to the tissue trauma and amount of dissection required for traditional “open” bunion surgery many patients have a significant amount of pain and swelling. This significantly lengthens the recovery period and means that many patients are off of their foot for up to two weeks.
DECREASED RANGE OF MOTION - After traditional bunion surgery a substantial amount of deep scar tissue is formed due to the large incision required dissection. This scar tissue inhibits the motion of the great toe and in many cases requires extensive physical therapy to return to normal function.
RECOVERY -
SCARRING - The traditional open method leaves behind a 1-2 inches scar which can be unattractive and sometimes painful requiring further treatments such as cortisone injections or scar revisions to treat.
MINIMAL INCISION - 5mm incision on the base of the big toe.
DECREASED PAIN POST-OPERATIVELY - As a minimally invasive procedure very little to no disruption of the surrounding tissue is required therefore pain and discomfort is substantially reduced.
MOBILITY - Almost all patients can walk out of the procedure with a surgical shoe and the assistance of crutches. Some patients can go back to work as early as the following day.
NO COMPROMISE ON RANGE OF MOTION - Due to the nature of the procedure very little deep scar tissue is formed, which the cause of constriction and decreased range of motion post-surgery. Most patients do not lose any range of motion of their big toe after this procedure.
RECOVERY - This procedure is so minimal that the swelling is not noticeable. Minimal swelling means minimal pain and that leads to patients going back to regular shoes as fast as 2 to 4 weeks (compared to the traditional method of 3 months)
SCARRING - The small size and hidden location of the incision as well as the No-Stitch closure provides for a nearly invisible scar post operatively.
Also referred to as a bunionette, is a bony lump that forms along the side of the smallest toe. This occurs when the fifth metatarsal bone swells up or shifts outward. The fifth metatarsal is the very bottom bone on the little toe. A bunion in this area can be painful, especially if it rubs against your shoe.
This type of bunion stems from wearing ill-fitted shoes, such as narrow, high-heeled shoes. The issue can also be genetical, because there’s a possibility you’ve inherited a structural foot problem from your parents. This problem could be that the bone in your little toe is in an abnormal position or the head of the bone is swollen, which causes the bone to move out of place.
Other causes include:
It’s common for tailor’s bunions to occur when you’re young as it gradually gets worse with time. By the time you reach your 40’s, the bunion can start causing pain.
A tailor’s bunion is the swelling of the outside area of your smallest toe and can also be red and painful. The bump might start out small with potential to grow larger with time. Bunions may get more swollen and painful when it rubs against your shoe.
You can get this type of bunion on one or both feet. The bunion on one foot may be worse than the one on the other foot.
Podiatrists should be able to diagnose tailor’s bunion just by looking at your foot. If necessary, an X-ray can identify issues with the bone of your little toe.
To help reduce swelling, you may need to receive injections of a corticosteroid around your little toe’s joint. Your doctor might also recommend a custom-designed shoe insert to cushion the bunion and prevent pain. If the pain and swelling persist, or if you can’t wear normal shoes because the tailor’s bunion has grown so large, surgery may be an option.
Because bunionette surgery is an outpatient procedure, you are discharged on the same day as your surgery. The surgeon will give you anesthesia to prevent pain and then shave off the tissue that is sticking out. Your surgeon might also perform a procedure is called an osteotomy, which is when they remove part of the bone in your little toe to straighten out the toe, and then the bone will be held in place with a screw, plate, or piece of steel wire.
After bunionette surgery, you need to keep weight off the affected foot. You will probably need to utilize crutches or a walker to get around, or have to wear a splint or boot for 3 to 12 weeks to protect your foot while it heals. You’ll have to stay home from work for a few weeks, especially if your job involves a lot of walking. Nonsurgical treatments can often resolve bunion symptoms within 3 to 6 months. After surgery, full recovery can take up to three months. Swelling in the affected toe might take as long as a year to return to normal. Physical therapy is also an option, as foot and ankle exercises after surgery can help keep your joints flexible while you heal.
This innovative procedure performed by Dr. Lopez can correct your hammertoe deformity with a simple and quick minimally invasive approach.
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This innovative approach to hammertoe correction utilizes a hidden plantar (bottom) incision on the affected toe. Unlike traditional hammertoe surgery where a large unsightly incision is placed on the top of the toe, with this technique the incision is hidden in the flexural surface so that there is no visible scar. Not only is this approach more cosmetically appealing but it requires far less trauma to the skin and underlying tissue. This means there is substantially less pain and swelling compared with the traditional method, as well as a faster recovery.
Hammertoes can cause you discomfort while walking or when you simply try to move or stretch your toes. You may also develop corns or calluses on the top of the toe and the ball of the foot and have difficulty fitting into your shoes. While in the early stages of a hammertoe, the joint may still be flexible and conservative therapy will provide sufficient relief, left untreated your toe will become more rigid and less responsive to these methods of care.
One of the most common toe deformities seen by our office is a hammertoe. Most often attributed to wearing ill-fitting, tight footwear or high-heeled shoes that squish the toes into a bent position, a hammertoe can also be influenced by genetic factors, the result of a bunion, or caused by arthritis in the toe joint.
A long toe is an abnormally long toe that can be straight or buckled. Over time, a straight long toe can buckle itself and form a hammer toe. All toes on the feet can be affected by this issue, but the most commonly affected to is the 2nd one.
Long toes are primarily hereditary, and can be inherited from genetics. The toe itself may be excessively “long” or the toes adjacent may be short in comparison – making a toe appear long. A short big toe will make the 2nd toe longer. Bunions can effectively shorten the great toe, making the 2nd toe appear longer. The presence of a bunion with a long 2nd toe can snowball into to a hammer or crossover toe.
Pain is commonly associated with the tip of the long toe. Excessive pressure from shoes may result in the formation of calluses on the tip of the toe. A buckled long toe can also cause pain and callus formation over the toe knuckles.
The toe(s) may become irritated, red, warm, and/or swollen, with pain ranging from dull and mild to severe and sharp. Pain is often made worse by shoes, especially designs that crowd the toes. Sometimes, long toes are not painful at all. Painful toes can prevent you from wearing stylish shoes.
There is risk for a long toe to develop into a hammer toe if the tip of the shoe pushes directly on the toe – causing it to contract. If the issue isn’t handled, the toe may become permanently contracted.
Non-surgical methods for a long toe are designed to decrease symptoms and/or limit the issue from snowballing into a larger problem.
Simple treatments patients can do are:
Long toes can be surgically shortened. Depending on the severity and length of the toe, there are several methods to surgically correct shorten a toe. In general, the surgery involves removing a portion of the bone at the contracted joint to realign the toe.
Recovery from toe shortening surgery is like recovering from a hammer toe surgery, depending on the method of surgery performed. In all cases, healing takes about six weeks in healthy people with no way to catalyze it. Patients often return to normal activities and shoe gear by 2-12 weeks depending on how severe the toe deformity was before surgery. Simple toe surgery can recover within two weeks. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.
A short toe, also known as a floating toe, is a condition when there is a growth defect affecting a bone in the foot creating a short toe. Though it can affect all toes, the short fourth toe is most commonly affected. The toe itself is usually normal in length, but the bone the toe attaches to in the arch (metatarsal bone) is short.
Short toe is primarily hereditary (although it can be the result of trauma) and affects women more than males. Short toe can also occur in people affected with Downs Syndrome. When dealing with short toe, the metatarsal bone growth is stunted whereas the surrounding bone grow normally. It’s usually noticed in early childhood during bone development. It is possible to for all metatarsals to be affected by short toe, although the most common metatarsal is the fourth.
Due to the unappealing nature of short toe, people affected by it are almost always embarrassed and constantly hide their feet or avoid being barefoot around others. Depending on the severity of the short toe, pain could be present. Weight distribution of the ball of the foot is altered with a short toe and can cause pain and pressure calluses.
A podiatrist should be able to identify short toe via visual examination. Depending on the severity, there are several methods to surgically correct a short toe. In general, the surgery involves lengthening the metatarsal bone with either a bone cut, bone graft, and/or gradual lengthening.
The basis for toe lengthening involves restoring the length to the short bone. The three most common techniques for correcting short tow are as follows:
Recovery after brachymetatarsia surgery generally depends on the method of surgery performed, and how short the toe originally was. The general time frame for full recovery can range from six to eight weeks. Large defects where the external fixator is used can involve casting up to three months.
Cross over toe is a condition where the second toe drifts toward the big toe and eventually crosses over and perches on top of the big toe. Crossover toe is a common condition that occurs at any age, although it is most often seen in adults.
Crossover toe is usually a result of abnormal foot mechanics, where the ball of the foot beneath the second toe joint receives an excessive amount of weight-bearing pressure. This pressure eventually leads to weaken supportive ligaments and cause a failure of the joint to stabilize the toe, resulting in the toe crossing over. Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of their foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Although the crossing over of the toe usually occurs over time, it can appear more quickly if caused by injury or overuse. Symptoms may include:
Crossover toe is a progressive disorder, meaning it is crucial to identify it and treat it as early as possible (when pain is present but no visual crossover of the toe). If it is not treated, the condition usually worsens.
Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The foot and ankle surgeon will select the procedure or combination of procedures best suited to the individual patient.
The basis for cross over toe surgery most often involves removing a portion of bone within the toe itself to achieve reduced joint contracture. The toe will also need to be relocated at the joint of the ball of the foot, with potential to undergo additional bunion surgery to make space for the relocated toe.
Repairing the buckled digit is the first phase in cross over toe surgery. The two most common methods surgeons use to correct the contractures are joint resection (arthroplasty) or bone mending (fusion).
The second phase of a cross over toe surgery is performing a joint relocation procedure at the joint of the ball of the foot. Sometimes, the ligament on the bottom of the foot will need to be repaired. If the toe is severely dislocated, a bone shortening procedure will be needed to return the toe back to its original position. A surgical wire is inserted to keep the toe stable and steady during the healing process.
The third phase of cross over toe surgery is correcting the bunion problem of the big toe. It’s vital to recognize that most of the surgical work involve the toe’s joints, not the joint of the ball of the foot. Sometimes a toe relocation procedure is required when the joint of the ball of the foot is misaligned.
The timetable for full recovery after cross over toe surgery ranges from six to twelve weeks, depending on just how severe the toe deformity was before surgery took place.
A plantar plate injury is when damage occurs to the strong supporting ligament of a toe, located on the ball of foot. The plantar plate is a thick structure that provides significant stability to the toe. Any to can be damaged, but the most commonly affected to is 2nd toe. Plantar plate injuries can be acute or chronic.
Plantar plate injuries tend to occur from the sudden and excessive upwards motion of the toe. The toe can dislocate and 'pop' back into place, and it is common for bruises to appear with severe injuries. A plantar plate tear can render the toe unstable, and there’s potential to develop into a hammer toe if it’s not treated.
Symptoms of a plantar plate tear include
The first step to assessing plantar plate injuries involve the use of Weight bearing x-rays. In some cases, the joint is injected with a special dye to find the tear in the ligament via a special radiographic x-ray.
Both acute and chronic plantar plate injuries can be repaired with surgery. Specific treatments depend on the extent of injury to plantar plate ligament, cause of tear, time from injury, the presence of a toe contracture (hammer toe), and the overall biomechanical foot structure.
The basis for plantar plate tear surgery involves sewing the ligament (plantar plate) back together in the proper position to repair the tear. Simple tears are straightforward. A complex tear usually involves a shredded plantar plate and requires special plastic surgery techniques to get the ligament ends together. Severe tears where the plantar plate is pulled off the bone involves using a special bone anchor secure the ligament to the bone.
Chronic plantar plate injury surgery is more complex than an acute injury. The problem with chronic injuries is that secondary compensations of the toe may have set in, making repair of the plantar plate secondary to a larger, unidentified problem. Usually plantar plate repair for chronic injuries necessitate supplementary procedures to balance the affected toe, especially if the toe is dislocated or buckled.
The full recovery time after direct repair of the plantar plate is about four to eight weeks. Because a plantar plate is a thick ligament that requires time to fully heal, there is no way to speed up the healing process. Patients need to be off the affected foot while the repair heals, and crutches or walkers are commonly necessary. The foot can be placed in a surgical shoe, removable boot, or cast depending on the severity of the repair.
Medically referred to as hallux limitus (limited arthritis) and Hallux rigidus (severe arthritis), arthritis of the big toe joint is a condition where the cartilage of the big toe joint becomes eroded, leading to limitation of motion and eventually rigidity. This results in a painful, enlarged, and/or inflamed big toe joint.
The two most common causes of arthritis of the big toe joint are biomechanical and traumatic arthritis. Inflammatory arthritis (i.e., rheumatoid) can occur but tends affect the rest of the body. Gouty arthritis is most common cause of arthritis in the big toe joint. Traumatic arthritis occurs after the joint is injured and not treated immediately, leading to more sever issues. Fractures that involve the joint, injuries to the cartilage, and sprains and strains can develop into arthritis. Biomechanical arthritis occurs from structural problems within the foot that lead to premature ‘wear and tear’ on the joint. Shoe gear can also play a role in arthritis development. Arthritis usually develops slowly over time until the flare-ups and pain reach a point where treatment is necessary to return to comfort.
Patients affected by arthritis of the big toe joint have varying degrees of symptoms depending on the severity of their arthritis. Usually, the big toe joint hurts with regular activity (i.e., walking and running), and the pain varies from superficial and achy to sharp and intense. Additionally, grinding sensations (known as crepitus) can be felt with movement of the affected big toe joint. Irritation from footwear can cause redness and swelling. If untreated, joint motion can become limited as time goes on, leading to extremely limited movement or ability to flex the toe.
There are two kinds of procedures to repair arthritis of the big toe joint: those that spare the joint (joint sparing procedures) or those that remove the joint (joint destructive procedures).
Sparing procedures surgically modifies or cleans up the joint in order to alleviate pain and maintain continued motion. Destructive procedures involve removing the joint and performing a fusion (locking the bone in place) or a joint replacement (utilizing artificial joint to allow motion). The severity of the arthritis determines whether the joint could be salvaged or not.
Recovery after big toe joint arthritis surgery is varies depending on the method chosen to fix the problem. Minor procedures (i.e., bone spur removal) allow patients to walk in a regular shoe in one to two weeks. If bone cuts are performed, patients have more restrictions and may be walking in a surgical shoe for six weeks or so.
Morton's neuroma is a benign but painful condition that affects the ball of the foot. It's also called an intermetatarsal neuroma because it's located in the ball of the foot between your metatarsal bones. This occurs when the tissue around a nerve that leads to a toe thickens from irritation or compression.
Morton’s neuroma is often caused by shoes that are too tight or that have high heels. Ill-fitted footwear can compress or irritate the nerves in your foot. The irritated nerve thickens and gradually becomes more painful because of the pressure on it. Another possible cause is a foot or gait abnormality, which can lead to instability and can also put pressure on a nerve in your foot. Morton's neuroma is commonly associated with:
It’s also associated with activities such as:
Pain is the most common symptom of Morton's neuroma. It may feel like a burning pain in the ball or your foot; like you’re standing on a pebble in your shoe or wearing a bunched-up sock. Your toes may feel numb or tingle as the pain radiates outward. People affected with Morton’s neuroma might experience difficulty walking because of pain, despite any noticeable swelling or any lack of symptoms period.
Surgery for neuroma most often involves removing the affected nerve in the ball of the foot through an incision made on the top of the foot. The nerve must be removed far enough back so that it doesn’t continue to become impinged at the ball of the foot.
Recovery after Morton’s neuroma (neurectomy) surgery is possible within a time frame of two to six weeks after the surgery, with possibility of wearing post-surgical footwear.
Performed exclusively by Dr. Ray Lopez this cosmetic procedure can decrease your foot by an average of 1-2 shoe sizes, giving you the petite elegant feet you have always wanted.
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It is no secret that many individuals wish they were born with smaller feet. In a fashion focused culture, it can be a struggle for those with larger than average foot size to fit into the designer brands they love. Having been approached by many patients wishing they could somehow reduce their shoe size, Dr. Ray Lopez has combined multiple established surgical techniques into one innovative procedure to do just that. The Foot Tuck™ is a cosmetic and reconstructive procedure that will deliver patient a 1-2 shoe size reduction in the overall size of their foot. This procedure will not only decrease the overall length of the foot but also reduce the width giving it a small slimmer appearance providing the patient with the petite and functional feet they have always wanted.
The Foot Tuck™ is accomplished by small hidden incisions in specific areas in the throughout the foot. Through these small incisions Dr. Lopez is able to contour prominent bony structures affecting the width of the foot and reduce the length of both the heel and toes. Two screws are then utilized to hold the heel bone in its reduced position. Depending on the desired amount of shortening, temporary fixation may be placed in the toes which will later be removed in the office. A cosmetic closure is then utilized on the incision sites to minimise any visible scars. This procedure is performed in an ambulatory setting under general or MAC anesthesia, with a total procedure time of less than 2 hours. Patients can go home the same day and walk with the assistance of crutches remaining non bear weight on the operative side.
After surgery the patient is placed in a splint followed by an air walker for 6-8 weeks. Patients are able to ambulate with crutches however should remain non weight bearing for approximately 6 weeks. After that the patient will be able to begin partial weight bearing on the operative side as tolerated and transition to normal shoes at around 8 weeks. Due to the reconstructive nature of this procedure mild pain and swelling is expected post operatively however is managed with oral pain medication and elevation of the extremity.
People with flat feet have a very low arch or no arch, meaning that one or both of their feet may be flat on the ground. Arches in feet are crucial as they provide a spring to the step and help to distribute body weight across the feet and legs, ultimately determining how a person walks. The arches need to be both sturdy and flexible to adapt to stress and a variety of surfaces. Without them, feet may roll inwards when standing and walking, a condition known as overpronation, that causes feel to point outward.
Common causes of flat feet include:
Another condition that might cause flat feet is tarsal coalition, a condition that causes the bones of the foot to fuse together abnormally, resulting in stiff and flat feet. People are more likely to develop flat feet if they’re obese, diabetic, or pregnant. Flat feet can develop with age too, as daily use of the feet can cause the arches to weaken. Damage to the posterior tibial tendon can enflame (tendonitis) and cause the arch to flatten. Flat feet can also occur from developmental faults that occur during childhood, developing with age.
The most common symptom of flat feet is foot pain. This occurs when muscles and connecting ligaments are strained, including abnormal stresses on the knee and hip may result in pain in these joints, common issues if the ankles turn inward. Pain most commonly affects the arch of the foot, calf, knee, hip, lower back, and lower legs. Flat feet can also cause an uneven distribution of body weight, resulting in faster degradation of shoes, specifically on one side, that may cause future injuries.
Qualified podiatrists can diagnose fallen arches by examining the feet and observing how the patient stands and walks. The feet should be inspected from the front and back. Sometimes, patients need to stand on the tips of their toes to allow the doctor to examine the shape and function of each foot. A doctor will also look at the person's medical history. In some cases, they may order an X-ray, CT scan, or MRI scan. It’s common for people with flat feet to automatically align their limbs in a way that prevents symptoms, making them hard to identify. If flat feet are causing pain, then supportive, well-fitted shoes can help, as well as extra-wide-fitting shoes. Fitted insoles and orthotics or custom-designed arch supports may relieve pressure on the arch and reduce pain if the feet roll too far inward. However, these products only treat the symptoms and do not provide long-lasting benefits.
People with posterior tibial tendonitis might also benefit from inserting a wedge into their footwear along the inside edge of the orthotic. This should relieve some of the load that the body places on the tendon tissue. Wearing an ankle brace may also be beneficial until the inflammation reduces. Doctors may advise rest until symptoms improve by avoiding activities that aggravate the injured area. A person with arthritis or a ruptured tendon might find that a combination of an the previously mentioned treatments can reduce their symptoms.
If these do not work, surgery may be necessary.
Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, the patient’s age, and whether the foot is stiff, the appropriate procedure can be assigned. In most cases, a combination of procedures are performed.
With flexible flat feet, surgery is designed to maintain the motion of the foot and recreate the arch. This involves tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is severe, bone procedures are included to physically reconstruct the arch and realign the heel.
With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. If motion in the affected foot does not exist pre-operatively, realigning it is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.
After surgery, your leg will be in a cast or splint. It is advised to keep it elevated as much as possible for the first two weeks to reduce swelling and speed healing. It is important to not put weight on the foot for six to eight weeks. At that point, you can start easing into weight-bearing activities.
The ankle joint is composed of the bottom of the tibia bone (shin) and the top of the talus bone (ankle). The top of the talus is dome-shaped and is completely covered with cartilage. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. This is referred to as an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.
Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage does not heal properly following the injury, it may soften and break off. Usually, a broken piece of the damaged cartilage/bone will float inside the ankle.
Unless the injury is extensive, it can take up to months, a year, or even longer for symptoms to develop. The signs and symptoms of a talar dome lesion may include:
A talar dome lesion can be difficult to diagnose because the precise site of the pain can be hard to pinpoint. To diagnose this injury, podiatrists should question the patient about recent or previous injuries and will examine the foot and ankle. It helps to move the ankle joint to help determine if there is pain, clicking or limited motion within that joint. Sometimes, your surgeon will inject the joint with an anesthetic to measure if the pain goes away for a while, indicating that the pain is coming from inside the joint. X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury.
Treatment depends on the severity of the talar dome lesion. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following nonsurgical treatment options may be considered:
If nonsurgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing.
Average recovery time after undergoing surgery to repair an osteochondral lesion of the talus ranges from four to six weeks. It is recommended that you avoid bearing weight until your ankle has healed. Crutches are usually prescribed for about six weeks, and you should rest as much as possible with your ankle elevated above your heart level.
A triple arthrodesis consists of the surgical fusion of the talocalcaneal (TC), talonavicular (TN), and calcaneocuboid (CC) joints in the foot. The goal of a triple arthrodesis is to relieve pain from arthritis.
Biomechanical problems or traumatic injuries are the main causes for foot arthritis. Inflammatory arthritis (i.e. rheumatoid) can occur as well. Gouty arthritis tends to affect the big toe joint. Flat feet can also cause arthritis in the back area of the feet. Arthritis usually develops gradually over time, with somewhat frequent flare ups until a defining point is reached resulting in ongoing pain and discomfort.
Patients with arthritis in their feet foot have varying degrees of symptoms, which are strongly dependent on the joints that are involved and the extent of the arthritic degeneration. Typically, the symptoms involve pain, swelling and stiffness. Arthritis can result in pain after periods of inactivity (such as getting out of bed in the morning, or after a standing up after a sitting for a while). As the joints loosen, the pain may diminish as the day moves on. The pain ranges from topical and achy to deep and sharp. Movement of the affected joint can result in a clicking feeling (crepitus). In more advanced cases, the joints develop bone spurs, which is the body’s mechanism for limiting the motion. Irritation from shoes can induce redness and swelling.
Depending on the symptoms and severity of the foot arthritis, treatment can be moderate and/or with surgery. Surgery for arthritis of the foot varies depending on the location and severity of arthritis, in addition to the presence of flat feet. But, in general, the procedures are separated in two kinds: Joint sparring (preserves the joints) or Joint destructive that fuses the joints.
Recovery time is dependent on which joint(s) are involved, as well as the surgical procedure. Arthritic bone spur removal is much less invasive, and patients can usually ambulate after surgery. Rearfoot fusion protocols typically require patients to avoid bearing weight on their foot and utilize cast and crutches until the bone mends – a process that can take six to twelve weeks.
A foot fracture can range in severity from a thin crack to a shattered or crushed bone. Because we depend so heavily on the intricate coordination of all the delicate bones that make up our feet, an injury that might seem minor still needs to be taken seriously. Like an elaborate belt and pulley system, each bone, ligament, and tendon is depended upon to make the whole foot function optimally. We can help you.
The most common ways of referring to different kinds of bone fractures:
If there is bone protruding from your skin, it’s easy to see the fracture, but there are many different kinds of foot fractures, most under the skin. You could have a single break or several. You could have a hairline fracture or a serious displaced fracture. If you’ve had a foot injury that caused ongoing pain, come see us.
The pain of a fracture is intense, and you may lose the ability to move your foot completely. Never try to fix a possible fracture on your own. Anytime you’ve injured your foot, you need to see a doctor, and MOSA has a proven track record. We can diagnose your injury quickly and see that you recovery promptly and correctly.
If you’ve had an injury to the foot, you need to see a doctor. But fractures can also be caused by osteoporosis and overuse. If your foot pain is intense, come see us immediately. We know everything about feet, and we can see you through any casts, splints, medications, or surgeries you might need, and then we can help you through recovery and any follow-up therapy you require. Don’t wait for an injury to heal on its own. You don’t want to take any chances where your feet are concerned.
Fractures can be caused by a wide variety of activities or situations.
Trauma is a common culprit. Fractures from trauma are typically caused by bearing all the weight of a fall on the foot, ankle, or leg, a vehicular accident, or a sports injury.
Osteoporosis can lead to fractures because bones are weakened by this condition and more easily broken by minor stressors.
Overuse is another cause because when muscles fatigue from overuse, the pressure on the bone may be strong enough to cause a fracture.
While there are always exceptions, if you have a fractured bone, you are usually in pain, particularly upon moving adjoining areas.
Time is of the essence in stabilizing the foot to avoid further injury, more swelling, and internal or external bleeding.
If you think you have broken a foot, the first step is to immobilize the affected area and get to a doctor or ER for evaluation. While you are in transit, a makeshift splint like a rolled magazine may help keep a broken foot supported. Keeping your foot raised and gently applying ice is helpful in reducing swelling, making treatment easier.
In the ER or primary care office, an X-ray may be ordered, or an MRI if soft tissue damage is suspected. Treatment of fractured bones falls into these broad categories:
Casts, splinting, and other appliances and aids are used in various combinations to allow fractures and joint dislocations to heal. This usually takes 3-6 weeks, depending on the nature and location of the break, as well as the age and overall health of the patient.
One of the most common orthopedic complaints, plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thick, web-like ligament that connects your heel to the front of your foot. It supports the arch of your foot and helps you walk. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. These ligaments serve as shock absorbers to support the arch of the foot. Too much pressure on your feet can damage or tear the ligaments, causing the plantar fascia to inflame, resulting in heel pain and stiffness.
Overweight or obese people are highly susceptible to developing plantar fasciitis because of the increased pressure on your plantar fascia ligaments, especially if you rapidly gain weight. It is common for women who are pregnant to experience episodes of plantar fasciitis during the final phases of their pregnancy. Long-distance runners and people with highly active jobs that involve being on your feet often (factory workers, restaurant server, etc.) are highly prone to developing plantar fasciitis. Active men and women between the ages of 40 and 70 can also be affected by plantar fasciitis, with women developing it more often than men. Structural foot problems (high arches, flat feet, tight Achilles tendons, etc.) can also lead to plantar fasciitis. Additionally, shoes with poor soles and arch support is also a common contributor.
Pain on the bottom of the heel is the most common complaint of those with plantar fasciitis, with some experiencing pain at the bottom mid-foot area. This develops gradually over time, and usually affects just one foot but can affect both feet. Plantar fasciitis pain can range from dull to sharp. It’s possible to feel a burning/ache on the bottom of the foot extending outward from the heel. The pain is worst in the morning, or if you’ve been sitting or lying down for a while, and climbing stairs feels impossible from heel stiffness. After prolonged activity, the pain can flare up due to increased inflammation. Pain isn’t usually felt during the activity but rather just after stopping.
A physical exam to check for tenderness in your foot and the exact location of the pain is necessary to determine that they’re not the result of a different foot problem. Your doctor may ask you to flex your foot while they push on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe, in addition to identifying mild redness or swelling.
Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your:
An X-ray or an MRI scan may be necessary to check that nothing else is causing your heel pain, such as a bone fracture.
If home treatments, over-the-counter, or anti-inflammatory drugs don’t ease the pain, an injection of a corticosteroid directly into the damaged section of the ligament can help by using an ultrasound device to help determine the best spot for the injection. Your doctor can also apply corticosteroids to the skin of your heel or the arch of your foot and apply a painless electrical current to let the steroid pass through your skin and into the muscle.
Physical therapy is a crucial aspect of treatment for plantar fasciitis. It can help stretch your plantar fascia and Achilles tendons. Exercises to strengthen your lower leg muscles can help stabilize your walk and lessen the workload on your plantar fascia.
An ankle fracture can range in severity from a thin crack to a shattered or crushed bone. Because we depend so heavily on the intricate coordination of all the delicate bones that make up our ankles, an injury that might seem minor still needs to be taken seriously. Like an elaborate belt and pulley system, each bone, ligament, and tendon is depended upon to make the whole ankle function optimally. We can help you.
The most common ways of referring to different kinds of bone fractures:
If there is bone protruding from your skin, it’s easy to see the fracture, but there are many different kinds of ankle fractures, most under the skin. You could have a single break or several. You could have a hairline fracture or a serious displaced fracture. If you’ve had an ankle injury that caused ongoing pain, come see us.
The pain of a fracture is intense, and you may lose the ability to move your ankle completely. Never try to fix a possible fracture on your own. Anytime you’ve injured your ankle, you need to see a doctor, and MOSA has a proven track record. We can diagnose your injury quickly and see that you recovery promptly and correctly.
If you’ve had an injury to the ankle, you need to see a doctor. But fractures can also be caused by osteoporosis and overuse. If your ankle pain is intense, come see us immediately. We know everything about ankles, and we can see you through any casts, splints, medications, or surgeries you might need, and then we can help you through recovery and any follow-up therapy you require. Don’t wait for an injury to heal on its own. You don’t want to take any chances where your ankles are concerned.
Fractures can be caused by a wide variety of activities or situations.
Trauma is a common culprit. Fractures from trauma are typically caused by bearing all the weight of a fall on the foot, ankle, or leg, a vehicular accident, or a sports injury.
Osteoporosis can lead to fractures because bones are weakened by this condition and more easily broken by minor stressors.
Overuse is another cause because when muscles fatigue from overuse, the pressure on the bone may be strong enough to cause a fracture.
While there are always exceptions, if you have a fractured bone, you are usually in pain, particularly upon moving adjoining areas.
Time is of the essence in stabilizing the ankle to avoid further injury, more swelling, and internal or external bleeding.
If you think you have broken an ankle, the first step is to immobilize the affected area and get to a doctor or ER for evaluation. While you are in transit, a makeshift splint like a rolled magazine may help keep a broken ankle supported. Keeping your ankle raised and gently applying ice is helpful in reducing swelling, making treatment easier.
In the ER or primary care office, an X-ray may be ordered, or an MRI if soft tissue damage is suspected. Treatment of fractured bones falls into these broad categories:
Casts, splinting, and other appliances and aids are used in various combinations to allow fractures and joint dislocations to heal. This usually takes 3-6 weeks, depending on the nature and location of the break, as well as the age and overall health of the patient.
Ankle arthroscopy is surgery that utilizes a tiny camera (referred to as an arthroscope) to examine and then repair the tissues in the ankle area. The procedure allows the surgeon to identify any issues and make repairs to your ankle without making larger, unnecessary cuts, resulting in less pain and quicker recovery times.
Arthroscopy may be recommended for these ankle problems:
Recovery times are dependent on the kind of surgery performed. Usually, you won’t regain the ability to walk on the leg for several months, and additional physical therapy is necessary for full rehabilitation. Sutures can be removed one to two weeks after the procedure, as mandated by your doctor.
Ankle Arthritis is a condition where the ankle joint cartilage degenerates and becomes eroded, coarse, and stiff, with the potential to become enlarged and full of bone spurs. The ankle joint is responsible for up and down motion of the foot, and is made up of two leg bones (tibia and fibula) and one foot bone (talus). Ankle arthritis can be painful and interferes with everyday life.
Biomechanical problems and trauma-based injuries are the most common culprits behind ankle arthritis. Biomechanical imbalances such as flat feet or general lower extremity malalignment may wear out the ankle joint, resulting in premature degeneration. Traumatic injuries such as ankle fractures may damage the joint structure or create malalignment leading to arthritis. Inflammatory arthritis can also affect the ankle joint. Arthritis usually develops gradually over a long period of time, with frequent flare ups until a critical point is reached resulting in ongoing pain, swelling and/or discomfort.
Patients with ankle arthritis have varying degrees of symptoms, which often correlate with the extent of the arthritic degeneration. Typically, the symptoms involve pain, swelling and stiffness. Arthritic pain may flare after periods of inactivity, with the joint loosening up and the pain eroding as the day progresses. Ankle arthritis pain ranges from dull to sharp. Movement of an arthritic ankle joint can result in a clicking or grinding sensation (crepitus). In unique cases, the ankle joint develops arthritic bone spurs – which is the body’s mechanism for blocking the painful arthritic motion.
Surgery for arthritis of the ankle varies depending on the location of arthritis, severity of arthritis, malalignment, and the presence of structural foot deformity (i.e., flat feet). In general, ankle arthritis procedures are separated in two kinds: Joint sparring (preserves the joints) or Joint destructive (eliminates the ankle joint through fusion or replacement).
Recovery depends on which surgery is performed. Arthroscopy and arthritic bone spur removal is much less invasive, and patients can usually walk after surgery. Ankle fusion and replacement protocols typically involve avoid any weight-bearing activities and require a cast and/or crutches until the bone mends – a process that can take six to twelve weeks.
Chronic ankle instability is a condition characterized by a recurring giving way of the outer side of the ankle, developed after experiencing repeated ankle sprains. Usually, this occurs during physical activities, but can also strike when you're just standing.
Chronic ankle instability usually develops after an ankle sprain that has not adequately healed or was not completely rehabilitated. When you sprain your ankle, the ligaments are stretched or torn, affecting your ability to remain balanced. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.
People with chronic ankle instability often complain about:
In evaluating and diagnosing your condition, the surgeon will ask you about any previous ankle injuries and instability. Then they will examine your ankle to check for tender areas, swelling, and signs of instability. X-rays may help in further evaluations of the ankle.
Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient’s level of activity. Nonsurgical treatment may include:
Podiatrists will recommend surgery based on the degree of instability or lack of response to nonsurgical treatments. It is common for these surgeries to repair or reconstruct the damaged ligament(s). The surgeon will select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.
Following surgery, the ankle is placed in a plaster splint and the patient must use crutches or a knee scooter to avoid placing any weight on the affected foot. At two weeks, the plaster splint is replaced with a cast or removable boot, which is worn for an additional 2 to 4 weeks. Formal physical therapy is started at 6 weeks and an ankle support is worn for walking until 12 weeks after surgery. By ten to twelve weeks, most people no longer require a brace and can return to all their normal activities including participation in sports.
The Achilles tendon is a large thick tendon located behind your ankle, and is the strongest tendon of your body. The Achilles tendon is formed from two muscles in the leg called the Gastrocnemius and the Soleus muscles and insert on the back portion of the heel bone. The function of the Achilles Tendon is to control the downward motion of the foot (also referred to as plantarflexion), or simply put, allows you to stand or walk on your “tippy toes”. A properly functioning Achilles tendon is crucial for walking, running, jumping and daily activity.
Generally, Achilles Tendon Ruptures are a result of a sudden or acute injury. It is very common for people to experience Achilles ruptures when they’ve lived non-active lives and suddenly engage in activities that are more intense than they’re used to, and even athletes too. Achilles tendon ruptures frequently occur when the Achilles tendon is overstretched with a sudden jump, pivot, sprint, or after a slip and fall. Achilles Tendon Rupture and tendons tend to weaken over time. Systematic medical conditions such as inflammatory arthritis and diabetes, in addition to certain blood types, may hinder tendon integrity.
It is common for patients to experience swelling, bruising, and intense pain as a result of a rupturing their Achilles tendon, with the potential of not being able to walk or stand on the affected leg. For the first several days, the injury is usually painful to touch., but exaggerated swelling may make this difficult to feel.
Achilles ruptures are diagnosed with patient history and several tests performed by a medical professional. During the exam, it is possible for surgeons to feel the rupture. A clinical test to evaluate for a rupture is with the Thompson test, which involves squeezing of the calf which to see if the foot moves. Another test involves having the patient lay on their stomach and bend both knees - if the feet are situated at different levels, there is a possible rupture. Unlike x-rays, ultrasounds may identify a rupture. Magnetic resonance imaging is the most accurate method for the viewing the Achilles Tendon and can readily identify a rupture, its severity and location, and possible tendon retraction.
The foundation of Achilles repair surgery involves re-attaching the ends of the torn Achilles tendon. The Achilles tendon repair involves weaving strong suture within the Tendon and tying the ruptured ends together. Repairs generally depend on the location of the tendon’s tear.
When the Achilles tendon ruptures centrally, there are tendons on both sides of the rupture. This is the most common area for Achilles tendon ruptures, which occur about 4 centimeters up from the heel bone. In this classic Achilles repair, the tendon ends are sewn together by weaving suture throughout both ends of the tendon. The ends are tied together centrally at the rupture site.
This procedure is ideal for when the Achilles tendon is ruptured directly at the heel bone. Simply put, the Achilles has been detached completely off the bone. The repair involves a tendon-to-bone re-attachment rather than repair of the tendon itself. A special suture with a bone anchor is used (commonly referred to as tenodesis). Several bone anchors can be used to secure the tendon to the bone, and the suture is also weaved into the Achilles tendon.
This is the most complex Achilles rupture because the Achilles tendon is torn directly at the junction of the muscle, which occurs higher up behind the ankle. This is more challenging to repair because muscle is more friable than tendon, and doesn’t hold the suture as securely. Nonetheless, the suture is weaved throughout the muscle.
Additional Achilles Repair Modifications: While the location of the rupture is important to determine the correct procedure, the severity of the rupture plays an important role in the repair. Sometimes, the tendon is completely shredded and simple repair is not possible. It is also common for shortening to occur with the rupture, which can be serious if not corrected at the time of surgery.
This repair involves rebuilding the Achilles tendon by using the tendon (flexor hallucis longus) responsible for curling the big toe down. This tendon also functions on the ankle as an accessory to bring the foot downward, and is optimal for use with certain Achilles repair surgeries. The flexor hallucis longus repair is a commonly utilize technique when rebuilding the Achilles tendon with chronic injuries.
Another technique to manage Achilles repair defects involves using the Achilles tendon itself to bridge the tendon gap. Here the top part of the tendon is specially cut, rotated, and flapped downward to bridge any gaps. This technique requires enough tendon available to flap down and is not a useful technique for ruptures close to the heel bone or at the muscle juncture.
This is an additional procedure where a small/tiny tendon, known as the Plantaris tendon, is used to support or augment the Achilles tendon repair. The Plantaris tendon is adjacent to the Achilles tendon, making it easier to access for surgeons, but its miniscule size makes it difficult to frequently utilize.
Tissue grafts may be utilized to augment the Achilles repair. The graft may be used to wrap the Achilles tendon repair after it has been sutured together. The tissue can be derived artificially, from animals or humans. Some surgeons find this technique useful whereas others prefer one’s own body for maximum healing results.
Structural tendon grafts from another person are uncommonly used for acute Achilles repairs and are only considered for tendon defects. Despite the limited availability of tendon allografts (especially since they’re sourced from someone else), they are not typically needed for acute repairs but rather used for chronic Achilles tendon repairs.
In general, most Achilles repairs are performed with an incision located directly along the Achilles Tendon. Minimally invasive surgery allows for a smaller incision located directly over the Achilles Tendon rupture site for mid-substance ruptures. The sutures are placed through pinholes and passed through to the ruptures site where they are tied together for the repair. However, because the technique is performed through limited access, the suture cannot be weaved in an interlocking fashion throughout the Achilles tendon. This does not speed the recovery process, but still results in proper functionality of the area.
Usually, it takes the Achilles tendon six to eight weeks to repair itself, with surgery options bringing about longer recovery times. Once the Achilles tendon has mended, physical therapy is recommended to gain full functionality, a complete process that can last about three months.
Gastrocnemius release is performed in corrective foot and ankle surgery, calf-contouring cosmetic surgery, or dermatologic, infectious, or oncologic pathologies that directly effect the gastrocnemius muscle. The gastrocnemius muscle is seldom completely resected to avoid lower extremity gait and stability issues. Generally, partial or subtotal resection of the gastrocnemius muscle is performed to achieve desired cosmetic or musculoskeletal results. Calf-contouring surgery for gastrocnemius hypertrophy has also been achieved through selective neurectomy of the sural nerve.
This procedure is suggested if a patient feels a sudden pain at the back of the leg, particularly at the muscular tendinous junction. Additionally, other causes include:
Gastrocnemius contracture results in the inability to bring the ankle joint past a neutral position (right angle to the lower leg) with the knee straight. Instead of walking on their toes, most people naturally and unconsciously compensate by having more motion through the joints in front of the ankle. This midfoot compensation often leads to increased repetitive pressure to various structures in the foot during standing and walking. Therefore, the presence of a contracture may lead to painful conditions of the foot.
The average recovery period for a gastrocnemius procedure is approximately six weeks. Patients may be allowed to return to a sedentary job within a few days after surgery. Patients with labor intensive jobs that require prolonged standing, squatting, kneeling, or stair/ladder climbing may not be able to return to work for approximately eight weeks or may return sooner with restrictions on these types of activities. If you’re surgery occurred on your right leg, you may not drive for up to three weeks.
A peroneal tendon rupture occurs when one or both peroneal tendons are torn, interfering with the functions of the foot and ankle. There are two main types of tears involving the peroneal tendons. One is a tear directly across the tendon, where the torn tendon ends separate, resulting in total discontinuity of the peroneal tendon, resulting in loss of function of the respective tendon. The other type of peroneal tendon rupture is a tear that occurs within the structure that splits the tendon (or a portion of the tendon) in half the long way so that the tendon remains functional.
Peroneal tears are the result of an injury, whether it be an acute injury or chronic overuse of the tendons that ultimately lead to a tear. Acute peroneal injuries generally occur when the foot turns inward on the ankle. The peroneal tendons can become injured in this scenario because they react by strongly contracting to counteract that inversion force, and when over-stretched or over-exerted, the tendon(s) can tear. Acute injuries can cause an immediate discontinuity of the tendon or a small tear of the tendon that can enlarge over time. Overuse of the peroneal tendon can lead to tears, especially when associated with high arched feet and/or unstable ankle ligaments that cause overexertion on the tendons. At times, boney prominences can irritate the tendons as they glide around the ankle, leading to chronic tears and/or splits in the tendon.
Acute peroneal tendon injuries are associated with specific trauma and often present with pain and swelling on the outside area of the ankle. It is possible for pain to manifest directly over the peroneal tendon rupture. A loss of tendon function can be detected but because there are two peroneal tendons, it can be deceiving to determine if a tendon is ruptured because the other tendon may function in its place. The symptoms of a chronic peroneal tendon tear/rupture can be subtle to intense. Pain is usually worse with activity, while swelling is common with chronic injuries.
Peroneal tendon problems are diagnosed with clinical exams and advanced imaging. Depending on the extent of the rupture, patients may have weakness when the specific muscle is tested by the podiatrist. Radiographs are useful to exclude other causes of foot and ankle problems.
Magnetic Resonance Imaging (MRI) is the optimal imaging study used to look for peroneal tendon pathology, making large tears with tendon discontinuity easily visible. Although tears can be identified via MRI, there can be false positives in the location where the tendon curves around the bend of the ankle. Fluid around the tendon generally indicates inflammation, while fluid within the heel bone may be associated with prominent bone rubbing against the tendons.
The foundation for peroneal tendon surgery is to repair the ruptured, torn and/or split tendon. The type of tendon repair depends on the location and extent of the rupture and whether there is discontinuity of the tendon.
Podiatrists will recommend surgery based on the degree of instability or lack of response to nonsurgical treatments. It is common for these surgeries to repair or reconstruct the damaged ligament(s). The surgeon will select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.
An end-to-end rupture is repaired with strong suture. The suture is weaved on each tendon end and then the ruptured tendon ends are tied together.
Also referred to as a longitudinal split, splits within the tendon are more commonly seen with chronic peroneal tendon ruptures. Small simple splits can be repaired by suturing the split together with an intratendinous stitch technique. At times, the split occurs off the central axis of the tendon and excising the smaller portion of the tendon is required. The remaining portion of the tendon is then repaired and made round again by a suture technique known as tubularization.
There are times when the peroneal tendon rupture and surrounding tendon degeneration makes the peroneal tendon unsalvageable. In this case the entire diseased portion of the peroneal tendon is completely excised. To restore continuation and functionality to the peroneal tendon, another tendon can be transferred to replace the function of the damaged tendon.
If one or both peroneal tendons are deemed unsalvageable, the other peroneal tendon can be used to function for both tendons. After the damaged portions of the peroneal tendon is removed, the peroneal tendon stump ends are sutured/secured to the other functioning peroneal tendon. This peroneal stop procedure is effective as both peroneal tendons have identical functions on the ankle joint as a stabilizer and similar functions on the foot. Additionally, the two peroneal tendons are located adjacent to each other so surgeons do not have to transfer a tendon from another area of the foot or ankle. The only caveat for this surgery is that the function of the peroneus brevis tendon must be maintained at its insertion onto the outside of the foot at the 5th metatarsal. The peroneus brevis function is more important than the peroneus longus function, and efforts should be made at recovering peroneus brevis function first.
Tendon grafts are also used in peroneal rupture surgery when both tendons are deemed unsalvageable, and when the peroneal stop procedure can’t be performed. Surgeons can harvest tendon grafts from another part of the body or use an allograft from a cadaver.
The peroneal tubercle is the normal prominent portion of the outer heel bone that acts as buttress to the peroneal tendons. In some instances, this bone is prominent, swollen, and/or misshapen – causing improper functionality of the tendon against the bone. In some cases, this bone should be filed down to prevent further or future damage.
Recovery after peroneal tendon repair surgery generally involves a period of immobilization. Small simple repairs may allow for immediate walking in a removable boot, whereas complicated repairs may require a cast and crutches for up to six weeks. Physical therapy is recommended as post-surgery care.
Haglund’s deformity is a bony enlargement on the back of the heel. When the bony enlargement rubs against shoes, the soft tissue near the Achilles tendon becomes irritated. This often leads to painful bursitis (an inflammation of the bursa).
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, any shoes with a rigid back such as skates, men’s dress shoes, or women’s pumps, can cause this irritation. Haglund’s deformity can also be hereditary. Inherited foot structures that can make one prone to developing this condition include:
Haglund’s deformity can occur in one or both feet. The symptoms include:
After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone.
The treatment for Haglund’s deformity usually focuses on relieving pain and taking pressure off the heel bone. Nonsurgical options include:
If less invasive methods don’t work, Haglund’s deformity can be treated with surgery. During surgery, your doctor will remove all excess bone from the heel and, if needed, will smooth and file down the bone, reducing the pressure on the bursa and soft tissue. General anesthesia may be necessary to perform this procedure.
You'll be allowed to leave and return home. The majority of patients who undergo the resection of Haglund’s deformity procedure will experience a full recovery within a period of four to six weeks.
Tarsal tunnel syndrome is a condition caused by repeated pressure that results in damage on the posterior tibial nerve. Your tibial nerve branches off of the sciatic nerve, located near your ankle. The tibial nerve runs through the tarsal tunnel, a narrow passageway inside your ankle that is bound by bone and soft tissue. Damage of the tibial nerve typically occurs when the nerve is compressed from constant pressure.
Tarsal tunnel syndrome results from compression of the tibial nerve, and is can be instigated by other conditions. Causes can include:
People with tarsal tunnel syndrome may experience pain, numbness, or tingling. This pain can be felt anywhere along the tibial nerve, but it’s also common to feel pain in the sole of the foot or inside the ankle. This can feel like:
Symptoms vary greatly depending on the individual. Some symptoms progress gradually, while other symptoms can pop up out of nowhere. Pain and other symptoms are often aggravated by physical activity, but if the condition is long-standing, some people even experience pain or tingling at night or when resting.
Tarsal tunnel syndrome should be identified and treated as soon as possible to prevent the condition from worsening. After inquiring about any histories of trauma to the affected area, medical professionals examine your foot and ankle to look for physical characteristics that could indicate tarsal tunnel syndrome. They’ll likely perform a Tinel’s test, which involves gently tapping the tibial nerve. Tingling sensations or pain as a result of that pressure indicates tarsal tunnel syndrome. Your doctor may also order additional tests such as electromyography, which is a test that can detect nerve dysfunction. MRIs may also be ordered if your doctor suspects that a mass or bony growth could be causing the tarsal tunnel syndrome.
In severe, long-term cases, your doctor may recommend a surgery called the tarsal tunnel release. This procedure involves the surgeon making an incision from behind the ankle down to the arch of the foot. They will release the ligament, relieving the nerve. A minimally invasive surgery is also used by some surgeons, in which much smaller incisions are made inside your ankle. Surgeon utilize tiny instruments to stretch out the ligament, creating the opportunity for reduced risk of complications and recovery time.
After the tarsal tunnel release, you will most likely be non-weight bearing for three weeks. After the splint is discontinued, you can begin gradual range or motion activities and return to weight bearing with possible use of a surgical shoe.
This outpatient cosmetic procedure utilizes your body's own fat and the latest in high definition liposuction to fill and sculpt your legs giving you the sexy defined calves you have always wanted.
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This minimally invasive procedure developed by Dr. Ray Lopez in conjunction with renowned plastic and reconstructive surgeon Dr. Tarik Husain utilizes high definition liposuction combined with fat transfer in a similar technique to abdominal etching and the brazillian butt lift. Depending on the patients goals, definition and slimming is obtained by high definition liposuction of the calf and ankle region through 1-2 small (less than 1cm) incisions located directly above and below the calf muscle complex. Volume addition is achieved by utilizing fat from an unwanted area such as the abdomen or thighs which is then strategically injected above the calf muscles, providing for a full muscular and toned appearance. This procedure is performed in an outpatient setting and takes approximately 1-2 hours per leg. Some soreness can be expected for the first few days post-operatively but is managed with oral pain medication. Patients will have a light dressing on the leg and fat donor sites and will be able to return to normal activity immediately.
It is no secret that the lower legs and calf region is a notoriously difficult area to train and define. Long hours in the gym and rigorous exercise programs may not always deliver the aesthetic results that patients are looking for. This is because genetics play a huge role in the size and shape of your calves and lower legs, in many cases predisposing individuals to have what they consider to be less than aesthetically pleasing. Whether it is slimming the calves to remove the notorious “cankles” or adding volume and definition to give a full muscular tone, Calf Sculpting may be the answer.
Traditionally there was little that could be done to help define and shape the lower legs. Patients such as fitness enthusiasts and bodybuilders looking to add more volume to their calves had few options other than implants to achieve their desired look. The traditional implant approach has numerous risks and is associated with a difficult recovery. Unlike implants, Calf Sculpting utilizes your own tissue which significantly decreases complications such as infection, compartment syndrome, and capsular contracture associated with calf implants, enabling not only the addition of size when desired, but also the option to define and shape the calves and lower legs.
Stem cell therapy is a relatively new innovative technique providing a blueprint for the body to heal itself. If your body experiences damage from injury, then you naturally recruit stem cells, hormones, and other cell types to restore the body. However, as your body ages, it does not do this at the same speed or effectiveness. By injecting stem cells to a damaged area, this stimulates cell growth and promotes repair.
After injury or surgery, a scar naturally appears as your body’s mechanism of repair, resulting in cells with no function and a disfigured appearance. Stem cells can regenerate the area’s structure and function so no scar tissue will form in that area. Stem cells have these properties because they can transform into almost any cell type. Like the hundreds of cells types throughout the human body, there are several categories of stem cells. Mesenchymal Stem Cells (MSC) give rise to most of the connective tissues in your body; they from the cushion under the skin, tendon and ligaments, cartilage, and bones.
Through years of medical research, there are various possible mechanisms to obtain stem cells and utilize their powerful transformative and healing properties.
If you are considering PRP treatments, be sure to check your eligibility with your health insurance provider. There are a few insurance plans (including workers’ compensation) that provide partial coverage or reimbursement. However, if your health insurance does not cover these treatments we offer competitive prices and accept Care Credit as a financing option.
Platelet Rich Plasma (PRP) treatments has been a successful innovation in the field of regenerative medicine to help people with long-term pain. The first reported medical use of PRP injections was in 1987 during an open heart surgery. Later the treatments gained popularity in 2009 when professional athletes of the Pittsburgh Steelers used such treatments which aided their victory at the 43rd Super Bowl. Once the public learned about the benefits of the PRP treatments, other professional athletes such as basketball player Kobe Bryant, baseball player Alex Rodriguez, golf player Tiger Woods, and MMA fighter Cat Zingano recognize the value and wanted to ensure their pain does not affect their game. Once known exclusively to star athletes and celebrities, this therapy was further studied and proved to be highly effective in healing and regenerating the body. In clinical settings, this treatment demonstrated success in eliminating pain of an old tendon injury, accelerating the healing process of bones after a break, and minimizing scar tissue after surgery. All these benefits can be achieved in the office and within thirty minutes or less.
Your blood is made up of gasses, liquids, and solids. The key component for PRP treatments is the solid cell fragments called platelets. These platelets are naturally covered with growth hormones, clotting factors, and other chemicals vital to the healing process. After an injury, your body sends messages to recruit more platelets to the wound site. In fact, you have seen this many times before. For example, a simple injury results in inflammation (redness, swelling, and heat), which is your body’s mechanism to bring more blood, and therefore more platelets with healing properties to the area. PRP treatments is mimicking this process but more efficiently. A small amount of the patient’s blood is drawn out with a needle, and spun down for several minutes. This separates the blood into three layers: the heaviest is red blood cells at the bottom, then a thin layer of platelets and immune cells in the middle, and finally plasma mainly composed of water at the top. For the PRP treatments, we inject the middle layer with a relatively higher concentration of platelets in the area of pain. This can then be applied in a couple of ways to help you:
If you are considering PRP treatments, be sure to check your eligibility with your health insurance provider. There are a few insurance plans (including workers’ compensation) that provide partial coverage or reimbursement. However, if your health insurance does not cover these treatments we offer competitive prices and accept Care Credit as a financing option.
Hyperhidrosis is the medical term to describe excessive sweating. It refers to any abnormal sweating (i.e., sweating when it’s not hot) and requires stronger antiperspirants to combat the condition.
Although neurologic, endocrine, infectious, and other systemic diseases may cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and psychological aspects may trigger hyperhidrosis in some, but many who suffer from it sweat throughout the whole day, regardless of their mood or the weather.
Most people sweat when they exercise or exert themselves, are in a hot environment, or are anxious or under stress. Excessive sweating from hyperhidrosis far exceeds normal sweating. Hyperhidrosis usually affects the hands, feet, underarms, or face at least once a week. Sweating also occurs on both sides of the body. See your doctor if:
Botox injections are a new treatment option for people with hyperhidrosis. You may be a candidate for Botox if your sweating fails to improve with prescription antiperspirants. Botox has been FDA-approved for people who sweat excessively from their armpits. It may also be utilized “off-label” to reduce sweating in other areas, such as the hands, feet, and face.
Despite being sourced from a neurotoxin from microbes that cause botulism, Botox is incredibly safe when administered appropriately by a medical professional.
The actual procedure typically takes 30 to 45 minutes, and patients return home the same day. Sedentary activity may be resumed within a day or two, and more physical activities after a week or two. The postoperative pain that may occur is minimal and can be treated by over-the-counter medication or mild prescription medications.
This in office procedure performed by Dr. Lopez will replace the lost or diminished fat pads in your feet which are a major cause of pain and discomfort.
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This unique in office procedure combines both dermal fillers ( the type used for lip and cheek bone augmentation) as well as the patient's own fat to replenish and restore their diminished fat pads. The hyaluronic acid based dermal fillers not only replaces lost fat volume but promotes your own bodies natural collagen synthesis. This collagen framework combined with the volume replacement provided by the patient's own fat cells creates a full long lasting plantar pad. Depending on the amount of atrophy (fat loss), a small amount of the patient's own fat will be taken from the inner thigh, processed, and injected in combination with dermal fillers. Ultrasound guidance is utilized to ensure safe and even distribution of the volume mixture. In total this procedure takes approximately 45 minutes and is done under local anesthesia. There is little to no pain associated with this treatment. Patients can walk out of the office in normal shoes and resume their daily activities immediately afterwards.
Anyone who wears heels for an extended period of time can attest to the pain they experience in the bottom or ball of their foot. In many cases this symptom is associated with a condition known as fat pad atrophy. The cushion or pad beneath the ball of the foot is made up of 3 distinct fat pads, which combined is known as the plantar fat pad. Over time, these fat pads can progressively thin (atrophy) due to prolonged pressures, usually associated with certain types of shoes such as high heels. The increased pressure on the pads created by these types of shoes can cause progressive degeneration of the fat cells and thinning of the very important fat pads. Patients experiencing this will often times complain of throbbing, aching, or soreness in the ball of their foot, which gets worse with prolonged walking or standing.
If you are having foot pain while wearing high heels, consider the Pump Pads™ procedure to replenish and restore your fat pads and keep you in the shoes you love. Walking in style no longer has to mean walking in pain!
This quick in office procedure will instantly take away those ugly spider veins and get you back to showing off those legs with confidence.
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Spider veins are easily removed with a quick in office treatment known as sclerotherapy. Sclerotherapy utilizes a safe and effective foam that is injected directly into the capillaries causing them to shrink and close right before your eyes.
Each treatment takes less than 30 minutes, with no downtime afterwards. Depending on the amount of spider veins, more than one treatment may be necessary for complete resolution, however you will see immediate results after the first treatment.
Spider veins are small, red, purple, or blue veins that are visible just below below the surface of the skin. They are actually swollen capillaries caused by deeper veins that have some level of backflow, and are most commonly found on your knees, thighs, and calves. While not usually painful, many patients can find these to be unsightly and cause them to feel self conscious about their appearance.
