Wednesday, July 24, 2013

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.

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


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.

Monday, July 15, 2013

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.

Wednesday, July 3, 2013

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.