Adult Acquired Flat Foot after Reconstructive Surgery

Adult Acquired Flat Foot aka Posterior Tibial Tendon Dysfunction aka Collapsed HindFoot.

At the Family Foot and Leg Center, PA. We see this condition way too often under diagnosed and under treated in the community at large.  Clinical exam will show that the patient is unable to do single heel raise test, meaning have difficulty in going tip toe on the one foot and noticing the arch gradually collapsing.
Patients will also complain about pain along the medial ankle (tibia), sometimes the patient may have nerve pain / impingement from the severe collapse of the ankle / hindfoot.

Here is a video discussing flat foot deformity in an adult with a patient and foot model.

Secrets to adult flat foot and painful arches with collapse. 1) Not all DPM's and Orthopedists are trained to treat this condition surgically.   Foot and Ankle Fellowship trained orthopods have special training to handle such condition but also varies by the practioner, if you feel uncomfortable get a second opinion.    DPM's that are board certified by the American Board of Podiatric Surgery in Reconstructive Rearfoot & Ankle Surgery have demonstrated the ability to handle hindfoot deformities and cases have been reviewed and verified, as of this publishing 950 DPMS in the country have this certification.     Most DPM and Orthopedists are supposed to be able to recognize this condition and refer to the appropriate subspecialist for your care.  In our area unfortunately, patients are referred far away from our practice due to political and financial gains.    No one does more reconstructive rearfoot and ankle surgery cases then FFLC in Collier County, FL.   2) Braces and orthotics can help to control the symptoms but will not solve the condition. Sometimes a brace and orthotics are the only thing that patients can use due to other medical conditions that precludes them from surgery such as PAD (peripheral arterial disease), poorly controlled diabetes mellitus, etc. 3) Early detection in grade I of the disease, vs grade IV in the disease with complete ruptured tendon has a greater chance of responding to less invasive care. Website: ABPS.org Some DPM's are Foot Surgeon certified Minority are double board certified in both Foot &  Reconstructive Rearfoot & Ankle surgery.  

Dr. Kevin K. Lam

Comprehensive Foot & Ankle Care

Post Residency Reconstructive Rearfoot / Ankle Surgery : Fellowship Director

www.NaplesPodiatrist.com

Office: 239 430 FOOT

Fax: 866 650 3324

Double Board Certified Podiatric Surgeon

• American Board Of Podiatric Surgery
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery
• American Board of Lower Extremity Surgeons
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery

Popping Peroneal Syndrome, Ankle Popping / instability by Dr. Kevin Lam

Dr. Kevin Lam: Popping peroneal syndrome on an 11 year-old child with classic symptoms. Basically, popping peroneal syndrome is when kids or adults come in complaining about “Hey, I feel a bone pop behind the ankle”. This is the grove where the peroneal tendons are supposed to be. The peroneal tendons are on the lateral or the outside of the ankle. So this is going to be right here on this side.

The tendon is supposed to run behind the fibula, come around, one attaches here, the other one goes underneath the foot and goes and attaches down here, so the two peroneal tendons.

Now, when we feel the pop, that tendon lies in front of this bone and it pops in front and that’s where that happens. A couple of different reasons why that happens is one, either the groove is too shallow, that’s one way. This is supposed to have a little pit, almost a “c” shaped groove in the back which this bone model shows a little bit right here. Some kids are born with ones that are too shallow.

Another thing is -- a less likely cause is patients are born with that tissue that holds it in being too weak. If that is too weak, we can still go ahead and repair that. An MRI will give us an idea of, if the groove is too shallow, we can go ahead and fashion a groove right here with a little bore, make it a deeper “c” shape and then reinforce and replace the tendon behind so that it won’t pop.

So now to the patient, here’s how we could tell. This is the fibula right here and this is the tendon that runs right behind it. This is the fibula outline and this is the tendon right here. Good anatomy lesson, this the peroneal tendon.

Now I’m going to have you put your toes over to that wall for me, okay? Point over there. Okay. As she points, we’re going to see this tendon bowstring, this tendon bowstring… relax… this tendon is going to bowstring to the side of the fibula. Point that way again, one more time. And that’s what causes the pop.

Dr. Kevin Lam: As you can see this tendon is very, very prominent, right here now. If I could see it right there, push, push, push, push… right here, it’s almost on the side of the fibula, right now. Relax. Now, tendon relocates. Now push again.  The tendon comes out to the side again right here. And that’s what the pop is.
Patient: Mhmm.

Dr. Kevin Lam: It’s more pronounced on the other side, but it’s harder to see. We’re going do it one more time. This is the peroneus brevis tendon, I’m tracing it from here to here, inserts into the base of number five.

You’re going to relax for me for one more time, we’re going to… right there. See that tendon? Just by doing that without her doing any force, this is called the peroneal tendon stress test. So I dorsiflex, make you do something called evert, so I dorsiflex and evert and this tendon would dislocate up front to the side. And I can feel a pop. You can hear the audible pop right now. I’m reproducing the pop.

Dr. Kevin Lam: Is that what you hear when you walk?

Patient: Yes.

Dr. Kevin Lam: That’s the peroneal tendon dislocation, peroneal popping syndrome. I can feel my hand and she could hear it and you can hear it at home, this popping sound from her tendon.

Now sometimes patients have a tear on this tendon, that’s what the MRI is going to tell us too. If there’s a tear, again, we could repair and replace it back. So there’s a couple of different things that can cause this. Number one, we went over the shallow grove, back here,  if it’s too shallow, that tendon can pop forward. Or if a patient has a tear in that tendon, it can pop forward. Or if the ligament – there’s a ligament that holds this behind called the peroneal retinaculum, it hold this tendon back. If she was born with a weakened ligament back here, that can also cause that tendon to pop forward. Now, the chance of her having a tear back here being the primary cause is fairly low because she has it on both sides. So most likely, one of the congenital deformities that was causing this popping to happen. So an MRI will be ordered, we’ll figure it out and we’ll come up with the best choice of care.

Dr. Kevin Lam: Any questions?

Patient: No.

Dr. Kevin Lam: Okay, good.

Post Scarless bunionectomy at 8 wks testimonial

In this video I talk about the ScarLess minimally invasive bunionectomy, AKA 5 mm bunionectomy.
Getting the word out to the public about the ability now to do this bunionectomy with very minimal incision and pain for the patient.   How are we able to do such?  

Mother nature is the answer.    By keeping our incision small we are able to keep all the ligaments, tendons and bone covering called the periosteum intact.  Use of modern interoperative xray technology we can guide the surgical blade live.   This combination allows for a very aggressive bunion correction without collateral damage for the patient.  

See the difference, if you have been afraid of bunion surgery due to pain or have had bunion surgery in the past and has recurred right after the surgery or years after.     This new technique can help with your problem.

See more information at:Scar Less Bunionectomy.  
You too can be a success story.
Come Join me on Facebook  where you will find interesting and up to date information about your foot and ankle.

5 Things you need to know about Adult Flat foot / Triple arthrodesis patient by NaplesPodiatrist.com

5 things you need to know:

1) Early Treatment can help to avoid surgery
2) Seek an ABPS.org  Reconstructive Rearfoot / Ankle Surgeon for your surgery as they have validated, board reviewed cases by peers for quality and consistency of care.
3) Custom ankle bracing is the gold standard conservative care
4) Surgical care is highly specialized and requires experience and specialization
5) If you are having collapsing arches and pain  you need to call us: 239 430 3668


Our Results Walk for Themselves.

Surgery for Chronic Ingrown Toenail

5 Secrets for Back to school shoe shopping to avoid year long foot pain / damage

5 Secrets for Back to school shoe shopping to avoid year long foot pain / damage

1) Measure the feet while standing on the measuring device
2) Shoes should not bend easily in the arch
3) Must Bend easily at the toes area
4) When standing the longest toe should be 1/2 inch from the end of the shoe
5) Width measurement as important as length

Video

5 Secrets of Bunion Surgery: NO Scar Bunion Surgery

Bunion surgery is the bread and butter of most podiatry practices.   Bunions comes in all shapes and sizes from mild , moderate to severe.     Most bunionectomies will require up to 6 week to fully heal but with the advent of new fixation techniques and now scarless bunionectomy a person can be up and about the same day!     The link below shows Dr. Ali K., a colleague discussing about the revolutionary procedure on the DOCTOR TV show that we feature here at FFLC.  
http://www.youtube.com/watch?v=zYjzGN-HfLY&feature=youtu.be

Secrets of Bunion Surgery

1. Most painful process / surgery
1. Truth: use of local anesthesia before surgery and after surgery with small amounts of steroid injected into the foot will significantly decrease the post operative pain experience, most patients only use 1 or 2 pain pills the day after. 
2. All Podiatrist and Foot / Ankle Surgeons are the same
1. Truth: Surgeon's skill varies by their experience and training.  Choose by the reputation of the surgeon. Ask operating room nurses and scrub techs at the hospital for an impartial opinion.  
3. All Bunion Surgeries Are the Same
1. Truth: Just as there are varying degrees of bunions, there are numerous bunion surgeries.  
2. Mild to moderate bunions requires  a certain class of bunionectomies
3. Severe to pediatric bunions requires another class
4. Bunions Recur
1. Truth: There is some truth to this, according to studies 20% of bunions recur after surgery
1. This is where the skill of the surgeon and selection of procedure becomes important
2. Majority of the recurrence is from improper selection of procedure. 
5. Bunion Surgery is Debilitating 
1. Truth: Newer techniques and screw fixation along with the scarless techniques have allowed patients to start walking in a surgical boot / shoe sometimes from day #1.   This will vary by patient's bone quality, your doctor will be the best judge of that. 

In conclusion: Bunionectomies have come a long way. Pain is no longer an issue with proper surgical technique of the surgeon and utilization of perioperative medication to minimize this pain and discomfort. 

Call for an appt with Dr. Kevin Lam  239 430 3668

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Recent Pre , During and Post Op Pictures

Notice the small incision.  Aggressive correction and severe lack of swelling.
This is an underlapping bunion where the 2nd toe goes above the bunion.
One wire is used for fixation but is removed at about week 4 to 5 without pain.

Preop:  Painful bump, ouch

Immediately Post op

No more bunion deformity immediately after surgery
Look: 2 stitches and no swelling.   Blue marker another
way to mark the planned bone cut. 

Surgical Cut planning with wire placement and retraction

Cut made and fragment stabilized

Video below shows how this modification can be used for revisional bunionectomies.

Accupuncture meets Western Medicine for Lower Extremity Pain Management

How P-STIM Can Help With Foot and Ankle Pain

Foot and ankle pain can prevent you from carrying out normal daily activities. Anyone can suffer from foot pain but certain groups seem to be at an increased risk, including people who are on their feet for long periods of time, people who are overweight, physically active people, as well as middle aged men and women.

There are many ways to manage foot and ankle pain. More and more people experiencing pain have found out about P-STIM, a device that controls pain effectively.

P-STIM is the first and only FDA approved, microchip controlled appliance for treating acute and chronic pain. The device performs continuous point stimulation over several days. It is placed behind the ear with adhesive and generates low frequency electrical pulses transmitted to the peripheral nerve endings in the ear through electrode leads. The patient can continue with the normal daily tasks without any trouble.

P-STIM involves pulse stimulation. It usually involves administering small 1 hertz stimulation to the pain access points. P-STIM enhances the release of endorphins which are the natural pain reducing hormones in the body.

How does P-STIM actually work?

In chronic pain cases, the imbalances in the nervous system cause the pain to worsen over time. The stimulation from P-STIM corrects these imbalances in addition to endorphin release to decrease the pain.

Therapy with P-STIM can be used by itself or in combination with other therapies for foot and ankle pain. For acute and chronic pain, the P-STIM should always be used for 4 days of therapy.

The use of P-STIM has its advantages over other pain treatments. Daily activities can usually be carried on without restrictions. This is also a drug free therapy with none of the side effects of painkillers such as tolerance, liver damage, and other adverse reactions. The procedure is done on an outpatient basis with little or no complications at all. The P-STIM is tiny and lightweight and comfy enough to wear behind the ear. The device can easily be placed and can also be easily removed.

Glucosamine for OsteoArthritis Management

lucosamine for the Management of Osteoarthritis

Osteoarthritis commonly occurs in the weight bearing joints in the body. It also affects the fingers, thumb, and large toe. The condition causes the joint to lose its elasticity and become stiff. Over time, the cartilage may slowly wear away and if the condition worsens, the bones could rub against each other.

The symptoms of osteoarthritis often develop slowly. The joint may hurt during movement and the joint may feel tender when light pressure is applied to it. Joint stiffness may also be most noticeable after a period of inactivity or when you wake up in the morning. There is also a considerable decrease in the ability to move the joints through its full range of motion. Other patients with osteoarthritis may feel a grating sensation when moving the affected joint.

Certain factors can increase the risk of developing osteoarthritis. Women are most likely to develop the condition. The risk of osteoarthritis also increases with age. Other factors are bone deformities, previous joint injuries, obesity, and repetitive stress on the joint.

Osteoarthritis is mostly treated with analgesics and nonsteroidal anti-inflammatory drugs. However, with long-term use, these drugs can cause adverse effects, particularly gastrointestinal and cardiovascular. Thus, disease modifying alternatives would be best. For the past years, glucosamine has been increasingly recommended to modify the course of the condition. People with osteoarthritis who take glucosamine may benefit from reduced pain and improved physical function.

What is glucosamine?

Glucosamine is a natural compound that is found in healthy cartilage. It is naturally produced in the body and plays a key role in building cartilage. It is an amino sugar that the body produces and distributes in cartilage and other connective tissue.

Several scientific studies have suggested the effectiveness of glucosamine in the treatment of osteoarthritis. The results suggest the glucosamine supplements may help reduce osteoarthritis pain. It is also helpful in reducing joint swelling and stiffness. Studies have shown that it helps improve joint mobility.

Since the natural glucosamine in the body is used to make and repair joint cartilage, glucosamine in the form of nutritional supplements are used in the management of osteoarthritis by helping repair damaged cartilage.

There are no major food sources of glucosamine. Oral supplements are available as glucosamine sulfate, glucosamine hydrochloride, and n-acetyl glucosamine.  

Natural Pain Relief from OsteoArthritis

How Flavonoids Can Help in Osteoarthritis Management

Flavonoids are plant pigments that are responsible for coloration, UV filtrations, symbiotic nitrogen fixation, act as chemical messengers, and cell cycle inhibitors. They are the natural ingredients found in colorful fruits and vegetables. Because they are naturally occurring pigments, flavonoids are one of the reasons fruits and vegetables are good for the body.

Preliminary research shows that flavonoids may modify viruses, allergens, and carcinogens. Like antioxidants, flavonoids help control the cell damage caused by free radicals.

A short-term randomized, double-blind study done by Levy, et. al. has shown that flavonoids and naproxen (nonsteroidal anti-inflammatory drugs or NSAIDs) appear to be equally effective therapies for symptomatic osteoarthritis of the knee when administered in full therapeutic doses for the short duration of 30 days. Currently, larger and long-term clinical trials are being conducted to confirm the initial studies.

Osteoarthritis affects millions of people around the world. The condition worsens over time and can damage any joint in the body. Symptoms include pain, tenderness, stiffness, loss of flexibility, and grating sensation. There are many causes behind the development of osteoarthritis. Among these are obesity, trauma, inflammation, genetics, repetitive motion, and diet. Problems can also arise in predisposed individuals when there is lack of intake of anti-inflammatory oils and micronutrients such as flavonoids which naturally control inflammation and help protect the joints against oxidative damage.

Flavonoid molecules have been known to possess anti-inflammatory properties. Their anti-inflammatory action in vitro involves the inhibition of different pro-inflammatory mediators. A new study showed that higher intakes of selected flavonoid subclasses were associated with modestly lower concentrations of inflammatory biomarkers. This shows potential in reducing the risk of chronic inflammation, including osteoarthritis. Flavonoids and other dietary antioxidants have been used in the management in osteoarthritis and in slowing its progression..

Foods rich in flavonoids include all citrus fruits, apples, berries, red onion, broccoli, parsley, hot peppers, celery, cocoa, green tea, chamomile tea, spices, and red wine. So make sure to eat plenty of colored fruits and vegetables. Medical products containing purified flavonoids can help maintain joint health and nutritionally manage the metabolic processes of osteoarthritis.

There is an FDA approved medical supplement: Limbrel 500mg which is 500mg of Flavenoid Acid, this has been proven to be effective in management in Pain from osteoarthritis. 

We also use the Monavie Mx drink which has soluble flavenoids from various courses and other antioxidants in the holistic management of osteoarthropathy. 

Ankle Sprain vs ankle fracture

The ankle is made up of 3 ligaments on the outside (fibula) and a cluster of ligaments on the inside (tibia side).    Typical ankle sprains are of a inversion or turning your foot in type of injury.     The most common myth, misconception that I hear from patients is that if they can walk on the ankle it is not broken.   Wrong!
Sometimes the ankle sprain or ligament rupture is more painful then an ankle fracture.   Often  times, I would see a patient one month after an "ankle sprain," only to find an ankle fracture or even a foot fracture.  This poses a problem as then we are dealing with a delayed fix if the bone is broken and needs surgery.

Lesson:  If you suffered from an ankle sprain, no matter how minimal, see your podiatric physician for an ankle and foot xray.  If caught early, you can avoid surgery or long term complications.  

Dr. Kevin K. Lam

Comprehensive Foot & Ankle Care

www.NaplesPodiatrist.com

Office: 239 430 FOOT

Fax: 866 650 3324

Double Board Certified Podiatric Surgeon

• American Board Of Podiatric Surgery
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery
• American Board of Lower Extremity Surgeons
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery

Protein for Tendon & Bone Healing

Protein for Tendon and Bone Healing

The foot is a common site for bone and tendon injuries. Tendons are tough fibers that connect muscle to bone. A tendon injury can happen as a result of many small tears to the tendons that have come about over time. Most of the tendon injuries occur near the joints such as the ankle. Anyone can have a tendon injury but those who make the same motions over and over in their daily activities, jobs, or sports are more likely to have tendon damage.

In the case of bones, any break of any size is called a fracture. If more pressure is placed on a bone than it can stand, it will break or split. A hairline crack can also develop due to repeated forces against the bone, which is called a stress fracture.

With the most modern and current treatment methods, most tendon and bone injuries heal without any problems. But for complete healing to happen, there should be adequate blood supply and stability. The blood brings oxygen, healing cells, and various chemicals to the injured site. These are necessary for healing. Poor healing is more likely to happen if the area has a limited blood supply. To hold the bone together, the doctor may use various ways to stabilize the injured area. In the process of healing, there are many phases of recovery. Healing restores the tissues to its original physical and mechanical properties.

Tendon and bone injuries also need adequate nutrition to heal. These include vitamin C, vitamin D, calcium, and protein. Without proper nutrition, the process of tendon and bone healing cannot be at its best.

Adequate protein is important for bone health and is especially essential to help heal and repair bone and tendon injuries. Proteins help synthesize a new matrix structure for the bone. Protein also provides the body with amino acids. The amino acids are necessary for tissue regeneration. Proteins also increase muscle strength, bone integrity, and improves the immune response.

Researchers have sped up bone healing in mice by 33% after using proteins to naturally regrow new tissues. Proteins are known to stimulate bone formation and tissue regeneration. Protein helps repair the damaged tissues.

Protein has a number of key roles in the body. Proteins are the main component of enzymes, which control many of the chemical reactions in the body. Proteins also play a role in having a healthy immune system. In the wound healing process, proteins are involved in the inflammatory response. They are also needed for the formation of collagen and elastin which provide the basis for new tissue formation. Because of the various roles of protein in the body, it can be said that it is indeed a vital nutrient in tendon and bone healing.

What is Board Certification in Podiatric / Foot and Ankle Surgery

I get asked this by my patients all the time for the information out there is very confusing even to other doctors who are not in our field.    A Podiatrist, Doctor of Podiatric Medicine (DPM) goes to college for 4 years, then attend Podiatric Medical School for another 4 hours.   The first 2 years are spent in the health basic sciences to help students hone up the science skills to become doctors, mostly a repeat of courses learned in college with a slant towards patient care.  These two years are usually spent with other student physicians such as D.O. , M.D. for the basics.   The next two years are spent doing clinical rotations with emphasis on foot and ankle medicine / surgery as well as other allopathic / osteopathic services that a Podiatrist will often interact with or share common privileges with.  These fields are Vascular, Plastic, General Surgery as well as Family/Internal Medicine, and Emergency , Trauma, Orthopedics, Anesthesia services.     Podiatric students skip psychiatry, OB, Optho, etc.  

After graduating with a D.P.M. degree the allopathic foot and ankle doctor then goes onto a residency training of at least 3 years now.     The first year is an internship usually and the last 2 years doing mainly surgery in the field of foot and ankle medicine / surgery via different services in hospitals.  There is an option to do a year or two or even more of a fellowship after residency for Podiatric Physician.   This is not mandatory and offers extra practice outside of residency.   Doctors at this stage typically learn how to practice in a real world setting.   With all this said, what really counts in choosing a foot / ankle physician?
Is a fellowship trained podiatric physician / surgeon better trained?   NO

Two words: Board Certification.   Fellowships are wonderful in that it allows the doctor to have additional apprenticeship under a Board Certified Physician and to practice the craft without having to worry about running a practice  or working independently yet.  

To be board certified by the American Board of Podiatric Surgery, the candidate needs to be in practice (not fellowship) for at least 4 years and compile over 1000 cases with a variety of situations, these cases are then scrutinized by a panel of Board Certified, nationally well respected surgeons in the field for quality and outcome.  Once that has been established then the candidate goes on to an oral examination whereby the candidates are given clinical scenarios, usually of complex cases which tests their clinical knowledge and judgement.   The American Board of Podiatric Surgery (ABPS) has two separate tracts.
1) Foot Surgery
2) Reconstructive RearFoot and Ankle Surgery

For those candidates who have both certifications, they would have pass two separate case review paths and then two separate oral examinations.    

Statistics by the American Board of Podiatric Surgery to date shows those with both Certifications in the United States is noted at 851 with 844 being active and practicing.     Those with Foot Certification @ 4,402.

What is the American Board of Podiatric Medicine and Orthopedics mean?    That is a board for none surgical podiatrist who are great at dealing with general medical issues and none surgical management of foot / ankle disorders.  Some specialize in orthotic therapy, dermatology, casting methods for foot/ ankle deformities and general medical management with prescriptions or minor procedures.  Most hospitals will require the podiatrist be board certified / qualified by the American Board of Podiatric Surgery as a gold standard to grant surgical privileges and procedures.

In conclusion, fellowships are great experiences for the Podiatric Physician / Surgeon, but the great equalizer is board certification, just as SAT equalizes the students across all schools.

Double Board Certified Podiatric Surgeon

• American Board Of Podiatric Surgery
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery
• American Board of Lower Extremity Surgeons
• Foot Surgery
• Reconstructive RearFoot & Ankle Surgery

Mark Hunt Broke His Toe In First Round Against JDS & Lost His Movement

Is this true asks www.BJPenn.com.   The big toe is a responsible for propulsion and yes, during a standup fight the push off for a kick, knee or just to move forward will be hindered.    The big toe is the propeller that pushes you forward.  
Mr. Hunt may not be off the mark with his complaint of loss of movement.

Hope he has a good podiatrist.

Antioxidants in Wound Healing.

Antioxidants and Wound Healing

Antioxidants are vitamins, minerals, and other nutrients that protect the cells from damage caused by free radicals. Free radicals are termed “free” because they are missing a molecule, which makes them go wild to pair with another molecule. These free radicals will attack cells to acquire their missing molecule. In the process, the free radicals often cause cell injury and DNA damage, leading to various conditions including cancers, liver disease, heart disease, as well as wound healing problems.

Free radicals trigger a damaging chain reaction. They do not just damage one molecule but can set off a whole chain reaction. This can overwhelm the body’s natural defense system and the damage can lead to a number of problems.

Antioxidants work to prevent or stop the damaging effects that free radicals have started. Various antioxidants work differently. Therefore, it is best to have a mix of vitamins and minerals to neutralize the free radical damage more efficiently.

There are numerous substances that can act as antioxidants. The most widely known are vitamin E, vitamin C, vitamin A, beta-carotene, manganese, selenium, glutathione, flavinoids, and phenols. Dietary souces include red beans, blueberries, cranberries, blackberries, raspberries, strawberries, artichokes, prunes, plums, apples, cherries, pecans, green tea, and many more.

It has been found out that antioxidants also help in wound healing. Wound healing requires a balance between oxidative stress and antioxidants. According to a study, the normal physiology of wound healing depends on low levels of reactive oxygen species and oxidative stress. An overexposure to oxidative stress leads to problems in wound healing. Antioxidants can help control wound oxidative stress and thereby speed up wound healing.

In wound healing, the body repairs itself after injury. Healing is a complex process of replacing devitalized cellular components and tissue layers. The process involves inflammation, proliferation, and maturation. In the inflammatory phase, blood flow is increased in the wound. In the proliferative phase, new blood vessels bring nutrients to the wound and dead tissue is removed. During maturation phase, the new skin seals the wound and may form a scar. Any agent that accelerates the process is a promoter of wound healing.

In the inflammatory response, neutrophils and cytokines produce oxidants, which act as free radicals. Antioxidants can therefore be used to reduce the oxidative stress and help in wound healing acceleration by donating electrons to the free radicals, thereby avoiding the damaging effects of oxidation.

Antioxidants have been found to improve wound healing. They have a role in the formation and maintenance of collagen during the healing of wounds. Other antioxidants can detoxify hydrogen peroxide which can cause damage to regenerating cells. Antioxidants also show promise in skin repair and regeneration. Thus, combinations of antioxidants have been used to enhance the healing of wounds.

UFC 159 Medical Suspension: Jones suspended indefinitely?

I know the injury was serious but indefinitely, may be too harsh.  Don't think this is a career ending injury, but a good inconvenience.  

UFC light heavyweight Jon "Bone" Jones Suffers "the worse" Foot / Toe injury

Jon "Bones" Jones is still the light heavy weight champ of UFC with his TKO of Chael Sonnen. 

I have to give Chael a lot of respect for his sportsmanship after the fight. 

What is more amazing is that it appears that the champ suffered a Hallux Interphalangeal joint dislocation if not an open fracture of the Hallux Interphalangeal joint.   

Above shows this injury.   This is NOT the Xray of Jon Jones but this is a similar injury that he sustained during his fight last night.    Typically seen when a person get's their toe caught on a divot in the mat  or canvas as they pivot to through a kick or establish ground control or dominance.  Seen in Tae Kwon Do athletes who practice on jig saw mats, as they use a lot of spinning kicks during sparring and training.    Joe Rogan said it right, "nastiest toe injury, I have ever seen."    I have been called to the ER in Naples for these injuries.  Some patients are able to be treated with a round of antibiotics as the bone is exposed to the air  / elements now for at least two weeks with a closed reduction of the deformity with an external splint.    Moderate cases may need temporary pinning with a steel wire in order to hold the joint in alignment, the pin is then removed at 6 weeks after the soft tissue heals around the injury.     Severe cases where instability is an issue a procedure called Hallux Interphalangeal joint fusion is required.  This is where the joint cartilage is taken out and the two bones are joined together to allow for stability.    Fusion procedures take 6-8 wks to heal.   Either way, this injury should not be a career ending injury for our Champ.    Easily treated with proper clinical judgement. 

Bad injury on a bad dude. Jon Jones now matches the winning record of Chuck the Ice man. All round great fighter and now a fellow Gracie Barra Jujitsu Brother, osss or oos in Japanese. 

Source of Xray taken from: 

http://radiopaedia.org/cases/traumatic-dislocation-of-the-distal-phalanx-of-the-hallux

Steve Tyler, Evan Longoria,Paul Duffy, Linsday Davenport, all have Neuromas in common

Celebrities with Neuroma

What is neuroma? A neuroma is a growth of nerve tissue. Morton’s neuroma is a painful condition that involves a thickening of the tissue on the nerve leading to the toes.

Symptoms of neuroma include a feeling of walking on a marble, feeling as if standing on a pebble in your shoe, persistent pain in the ball of the foot, burning pain that may radiate to the toes, tingling or numbness of the toes.

The exact cause of Morton’s neuroma is unknown. It seems that the condition occurs in response to pressure, injury, or irritation to one of the nerves leading to the toes. Using high heeled, too narrow, or tight shoes can make the pain worse. Certain foot conditions are also believed to play a role in its development. Among these are abnormal positioning of the toes, hammer toes, high foot arches, bunions, and flat feet. Morton’s neuroma is more common in women. The female to male ratio is around 4:1. Symptoms are usually unilateral and they tend to occur in the fifth decade of life.

Celebrities have also been affected by Morton’s neuroma. Steven Tyler, the frontman of the rock band Aerosmith has been the talk within the podiatry community when he was seen with deformed toes. It was reported that he has accepted the offer to be a judge on the American Idol show to spend some time off of his feet. He was apparently in constant pain because of neuroma. He told Billboard magazine in 2011 that he suffers from Morton’s neuroma. He has been through operations and was constantly in pain.

Lindsay Davenport, a former World No.1 American professional tennis player has also suffered from neuroma. Although this has caused great pain in her foot, she continued to play. She had said that the pain comes and goes. Later on, she had surgery to deal with Morton’s neuroma on her troublesome left foot.

American actor Patrick Duffy, best known for his role as Bobby Ewing in the soap opera Dallas reportedly said he has terrible feet. He said that he really beat them up during his role in Man from Atlantis because he was apparently barefoot all the time. He was running on cement, running through fields, and slapping his feet around for years so the nerves on the bottom kind of went berserk. He had to have an operation because he developed Morton’s neuroma.

Major League Baseball third baseman for the Tampa Bay Rays Evan Longoria had one of the biggest hits in Rays history when he hit a walk-off home run in extra innings of the last game of the 2011 season. But he also had his share of foot problems. He had said that he ran on his toes in an effort to reduce the pain from his Morton’s neuroma but he ultimately needed surgery to fix the condition. He developed neuroma between his third and fourth toes, where it most commonly occurs. He was able to resume workouts shortly after the surgery.

Morton’s neuroma is common among dancers, runners, and other athletes but can affect anyone. If you feel that you might be suffering from Morton’s neuroma, seek advice from a doctor or surgeon who specializes in foot disorders.

Treatment depends on the severity of your symptoms. This may include arch supports, custom made shoe inserts, steroid injections, decompression surgery, or removal of the nerve if other treatments fail to provide relief.

Family Foot and Leg Center in Naples, FL specialized in the latest in neuroma therapy. Sclerosis injections to help eradicate the nerve via the use of a alcohol mixture as well as radio frequency ablation by using heat to solve this painful problem without surgery. Given that neuroma surgery has a 50% failure rate, conservative , none invasive options should be explored first.   If you have had surgery and still have pain, a cause could be scar tissue formation around the nerve stump.   Shockwave therapy has proven to be helpful in those situations.

GET FREE REPORT ON SECRETS OF NEUROMAS  

Call 239 430 3668 for consultation.  

Dr. Kevin Lam

Celebrity's and their Ugly Bunions

What is a bunion? This is a bony bump that forms on the outside edge of the big toe. It is estimated that half of women in America have bunions. In fact, it is so common than even celebrities are not spared from this foot condition.

Victoria Beckham, for instance, has not made it a secret that she has problems with her feet. In the past, she has reportedly stated that the ugliest thing about her were her feet. Her penchant for wearing high heels may have resulted to the development of bunions.  Shoes with high heels are commonly damaging to the toes. Victoria is seldom without her towering heels, which may have led to bunion formation.

Wearing elevated heels regularly is known to put unwarranted pressure on the foot. Thus, it is not surprising that a lot of models, such as Naomi Campbell, develop bunions. Celebrity millionaire Oprah Winfrey is not spared from the infamous bunions. Rumors still circulate whether or not she had bunion removal. Although she wears heels during her television appearances, she is known for kicking her shoes off once she goes off the camera. 

Celebrities may look glamorous in towering stilettos but this puts them at more risk of bunion formation. Aside from frequent use of high heels, another contributing factor to development of bunions is wearing too tight shoes. All the stress exerted on the foot from wearing improper footwear can put increased stress on the big toe joint. The extra strain on high heeled shoes or too tight shoes can hasten the formation of bunions in those who are inclined to develop them.

Genetics also plays a significant role in bunions. If the condition runs in the family, then it is more likely to have them. Sometimes, foot injuries can also be a factor. Other risk factors are certain nerve conditions that affect the foot, rheumatoid arthritis, congenital reasons, or occupational factors, for instance among ballet dancers.

Bunions may or may not cause foot pain. A bunion is seen as an enlargement of the base of the big toe. Later on, it can get larger and then sticks out. The skin over the bump may be tender and reddish. As the bunion gets bigger, the more it hurts to walk. In others, the pain can become chronic and the pressure from the big toe may force the second toe out of alignment.

In diagnosing bunions, the physician will do a thorough physical examination of the foot as well as an x-ray to assess the severity and possibly identify the cause of the bunion.

Although bunions do not always cause problems, they are permanent. The treatment options depend on the size of the bunion and severity of the pain. For smaller bunions, wearing comfortable shoes, using foot pads, and avoiding high heeled shoes can reduce stress on the bunion and decrease pain. Over the counter arch supports or prescription orthotic devices can provide relief. Medications such as acetaminophen, ibuprofen, naproxen, or cortisone injections can be helpful.

Larger bunions can get more painful and only surgical correction can be an effective solution. Often, this includes a bunionectomy which includes removal of the swollen tissue around the big toe joint, straightening the big toe, realignment to straighten the abnormal angle in the big toe joint, and permanently joining the bones of the affected toe joint. 

Old fear of painful bunion surgery is unfounded in our practice as our patients typically take only 1 or 2 days of pain medication in anticipation of agonizing pain that does not exist.   Our secret to painless bunion surgery?   Careful tissue handling and surgical technique by the doctor, quality peri-operative local anesthesia and proper use of steroids and anti-inflammatories during and after surgery. 

Prior to making the first incision the patient's foot / ankle is blocked with local anesthetic such as what a dentist would do prior to drilling teeth.    This initial injection stops the pain response of the body before it even starts.   Then at closure time another injection is given with a 24 hour local anesthetic to decrease post operative sensation or stress of surgery.    Most of the time a mild steroid is given as well as an intravenous strong none steroid anti inflammatory.   All these extra steps are taken to ensure a smooth and painless recovery from bunion surgery. 

Family Foot  and Leg Center, PA
661 Goodlette Road, Suite 103
12250 Tamiami Trail East, Suite 101
1660 Medical BLVD, Suite 302
Naples, FL
239 430 3668 for central scheduling.

AFO

Secrets to Neuromas

Neuroma and its Various Treatments

A neuroma or Morton’s neuroma is defined a painful condition that involves the ball of the foot. Commonly, the area between the third and fourth toes is affected. The pain can be felt as sharp burning pain, stinging, or a feeling of numbness. In a small number of patients, the nerve pain can occur between the second and third toes.

The reason behind this is usually because of an injury, irritation, or pressure. A neuroma is sometimes described as a nerve tumor although this may not always be true. A neuroma is a swelling in the nerve that may bring about permanent nerve damage.

Although the exact cause for neuroma is unknown, there are certain factors that are believed to play a role in its development. These include having flat feet, high foot arches, abnormal positioning of the toes, bunions, and hammertoes. Wearing tight fitting shoes and high heels was also found to be a contributing factor. This may be why more women are affected compared to men.

If you have persistent foot pain of have continuous foot tingling, it is best to see a podiatrist. Helpful information would be the type of pain felt and how much pain is involved. Inform the physician about foot conditions that you have, what type of shoes you usually wear, your work, sports activities, and lifestyle.

In the diagnosis of neuroma, a thorough physical examination is the first step. There is usually tenderness on the involved area upon compression. Sometimes, there is a tingling sensation when the sides of the foot are squeezed. To rule out bone problems, a foot x-ray is often done. Other tests are magnetic resonance imaging or MRI, ultrasound, and electromyography or nerve testing.

There are basic treatments that usually resolve the pain in neuroma. Resting the foot is the simplest. Using foot pads or arch supports can help minimize the pressure on the nerve. These can either be custom made or bought over the counter. Taping the toe area is another way to manage pain. Staying away from high heeled shoes and wearing shoes with wider toe boxes also help.

Taking anti inflammatory medications, other painkillers, or injection of nerve blocking medicines into the toe area may also be suggested. However, painkillers are not to be used for long term management. Cortisone injections and the use of orthotics may be combined to manage the condition.

Another alternative is chemical destruction of the nerve or chemical neurolysis with 4% alcohol with sarapin and phenol can be used. This involves a series of injections using a local anesthetic mixed with an alcohol solution. Repeated exposures to chemicals destroy a part of the nerve which is causing the pain.

In a small percentage of patients, surgery may be needed. This is especially true when the nerve has become damaged permanently. Decompression surgery involves cutting nearby structures to relieve pressure on the nerve thereby alleviating neuroma pain. Sometimes, surgical removal of the nerve may be necessary if other treatments do not provide relief from pain.  As with any surgical procedure, complications can occur such as excessive swelling, infections, healing problems, bleeding, scarring, or continued pain. Regrowth of a more painful neuroma can happen also.

ESWT or extracorporeal shock wave therapy is now also starting to be utilized for neuroma pain that does not respond to the usual methods and an alternative before proceeding to surgery. In this treatment method, powerful but painless energy pulses are used to induce microtrauma to the tissues. In turn, the natural healing process is induced in the area. Studies have shown the potential of ESWT neuroma treatment for persistent pain that is not responsive to the usual management methods. This technique is great for people with previous neuroma surgeries where it is actual scarring that causes the pain. In our practice, Family Foot and Leg Center, PA 80% resolution in 4 wks and 100% resolution in pain after the 5 months for majority of patients who have undergone ESWT for treatment of pain after neuroma surgery.

Our newest addition it the RF ablation therapy. It is heat that is generated by a probe that injures the nerve to the point where it no longer sends pain signals. Pain management doctors have been doing this for the neck and lumbar spine issues. FFLC, has been using this for neuroma management with great success for those that fail the usual treatments as mentioned earlier.

We have minimized greatly the number of patients having to undergo neuroma surgeries. This surgery very unpredictable even in the best of surgical hands.

Family Foot and Leg Center, PA

www.NaplesPodiatrist.com

239 430 3668 for Centralized Scheduling.

3 locations to serve you:

661 Goodlette Road, suite 103 Naples, FL 34102

12250 Tamiami Trail East, Suite 101 Naples, FL 34113

Royal Palm Medical Building
1660 Medical Blvd, Suite #302
Naples, FL 34110

Soon to come:

Fort Myers

3596 Broadway Fort Myers, FL  

Pediatric Flat Foot

Often, I would get a consult for pediatric flat foot / feet deformity from the pediatrician or concerned parent. General rule is that if the child has a flexible flat foot that  can be controlled with a true custom orthotic device such a UCBL (University of California Berkeley Labs) type orthotics and some Achilles stretching exercises then the child would just be monitored over the years.  If despite the conservative treatments above the child still has pain then surgical correction will be discussed.  Not all pediatric flat foot deformities require surgery only a small percentage would actually need corrective surgery.   Please refer to my post below about adult flat foot ,etc below for more information.

Part I

Part II discussion