Tuesday, December 30, 2014
There are many ways to fix a flat foot. This patient is an older patient and lives alone, a 12 wks nonweightbearing in a cast after a triple arthrodesis procedure is not a good option for this patient due to social conditions. Discussed using the hyprocure implant as an option to allow for quicker recovery. The results for this patient was amazing. She is ready to do the opposite foot, the trick of this surgery is to make sure the ligaments in the subtalar joint are released properly and proper sizing of the implant itself.
Monday, December 1, 2014
Lump on back of the heel is the complaint most people put as the reason for their office visit. Diagnosis for this case is: Haglund's deformity (aka pump bump), Achilles tendonitis / Tendonosis
Burning in the achilles, unable to run, jump or wear shoes due to the rubbing of the achilles.
Tightness in the Achilles
See 1) NSAIDS such as motrin, etc if tolerated
2) Physical therapy
5) Avoid shoes that rub on that area.
7) Platelet Injections / Stem Cell therapy
Below is an actual FFLC patient preop Xrays and clinical photos.
|Notice the bump right above the achilles insertion|
|Another view of the swelling|
|Side view of the painful bump|
|What is looks like on Xray, Multiple issues to be addressed.|
1) Haglund's Deformity (top Arrow)
2) Insertional spur growing into the achilles tendon (bottom arrow)
3) bone cyst / erosion from chronic inflammatory condition.
Where are the fibroma commonly located in the foot?
Thursday, November 13, 2014
The two main types of arthritis — osteoarthritis and rheumatoid arthritis — damage joints in different ways.
The most common type of arthritis, osteoarthritis involves wear-and-tear damage to your joint's cartilage — the hard, slick coating on the ends of bones. Enough damage can result in bone grinding directly on bone, which causes pain and restricted movement. This wear and tear can occur over many years, or it can be hastened by a joint injury or infection.
In rheumatoid arthritis, the body's immune system attacks the lining of the joint capsule, a tough membrane that encloses all the joint parts. This lining, known as the synovial membrane, becomes inflamed and swollen. The disease process can eventually destroy cartilage and bone within the joint.
- NSAIDS: Motrin, Aleve, etc
- Steroid injections
- Platelet Rich Plasma injections
- Amniotic stem cell injections
- Ankle arthroscopy (scope of the ankle to roto rooter out the ankle joint)
- Ankle arthrodiastasis (stretch out the ankle joint after an ankle scope to provide room for new cartilage growth and recovery)
- Denovo Juvenile cartilage grafts
- End stage ankle fusion or ankle implants
Tuesday, November 11, 2014
A ganglion cyst is a fluid filled sac usually with synovial synovial fluid. The synovial fluid has a very high viscosity which is the same fluid as a joint or a tendon which are two of the most common sites of origin of this to cyst. However, there are situations , and conditions that mimic a ganglion cyst that can be cancerous they are synovial sarcoma, giant cell, tumors or even bone tumors, an MRI scan with contrast can help to differentiate the lesion. Your podiatric surgeon will assess your individual situation. Those that require excision are: rapidly increasing in size, discoloration or limits your ability to walk.
Additional information from the American College of Foot and Ankle Surgeon about ganglion cyst below.
- A noticeable lump – often this is the only symptom experienced
- Tingling or burning, if the cyst is touching a nerve
- Dull pain or ache – which may indicate the cyst is pressing against a tendon or joint
- Difficulty wearing shoes due to irritation between the lump and the shoe
- Monitoring, but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.
- Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.
- Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others the cyst returns.
FFLC treats these and other foot / ankle ailments with ease. Call: 239 430 3668 option 2.
Friday, November 7, 2014
Did you know that if you have ingrown nails, there is a 50% chance that your child will get ingrown nails?
If you have flat feet that caused terrible hip and back pain, your child may be doomed to such without proper monitoring and preventative care, a simple orthotic can help your child develop properly.
Thursday, November 6, 2014
Medicine and surgery changes very fast nowadays with innovative products and techniques. Glad that the minimally invasive bunionectomy via the Lam modification is gaining traction as other doctors and more FFLC patients see the benefits.
Patients are able to walk the day of surgery in a boot, even had a plastic surgeon return back to work 3 days after surgery! This surgeon definitely appreciated the 6 mm bunionectomy.
www.ScarlessBunion.com to see more photos and actual patient pictures.
Thursday, October 30, 2014
Monday, September 22, 2014
Symptoms are redness, swelling, warmth of usually one let. Present to the nearest emergency room immediately to get checked. Any medical treatments and surgeries done up north, please bring a copy with you to your doctors here in SWFL.
Make sure that if you have had any address , insurance company changes, you let your doctor's offices here know about such.
Welcome back, enjoy our weather and hospitality. If any of our patients requires a referral to a generalist or another specialist, please feel free to contact your FFLC doctor as we have a wide network and have the inside information for your safety.
We have 3 offices to service your needs:
661 Goodlette Road, Suite 103
Naples, FL 34102
12250 Tamiami Trail East, Suite 101
Napes, FL 34113
1661 Medical BLVD, Suite 302
Naples, FL 34110
Call: 239 430 3668
Fax: 239 692 9436
Jon Bon Jovi and Dr. John Connors
At Riverview, under the care of Dr. Connors, Jon underwent endoscopic plantar fasciotomy (EPF), which is a minimally invasive and minimally traumatic surgical treatment for chronic plantar fasciitis. Six weeks is the typical recovery time for this surgery. “Exactly six weeks later, Jon was again walking and jogging on the treadmill,” Dr. Connors added. “He is now 100 percent for the first time in years.”
Source: Robert Cavanaugh, Meridian Health Views [September/October 2014]
From Dr. Kevin Lam:
EPF is a procedure using small stab incisions and a 4mm camera used to visualize the plantar fascia then a blade is inserted from the opposite side to cut the fascia to relieve the pain. FFLC has this and newer technology for those nagging heel pains.
Wednesday, September 10, 2014
September 17th is National School Backpack Awareness Day
The kids are back in school and toting around those ever–present backpacks crammed with books, notebooks, electronics and lunch. But all too often a backpack can weigh 12–15 pounds, which can be too heavy for a child’s frame to carry.
A too–heavy backpack can lead to poor posture and back pain and injuries, such as:
Carrying a backpack that is too big or heavy also changes the way kids walk, putting them off balance. This increases the risk of falling, especially on stairs, and can cause foot and ankle injuries like torn ligaments and sprains.
Visit the American Occupational Therapy Association (AOTA) website for information on this year’s National School Backpack Awareness Day on September 17th. You’ll find helpful information on injury risk factors and strategies for choosing and loading a backpack properly. Here are a few examples:
Monday, September 8, 2014
The other topic being brought up is should an 81 year old have elective surgery? Some 40 year olds I've seen are in worse shape health wise then my 85 year olds that walk 5 miles a day etc. Age is nothing but a number is correct, the health age is more important. Just because a person is over 65 does not mean they are over the hill for elective surgeries. For myself as a podiatrist, most of what I do is elective such as bunions, hammertoes, fusions, ankle arthroscopies, as long as the patient is healthy enough and active risk of anesthesia death is relatively low.
Wednesday, August 27, 2014
Heard this a million times. What we have always trained our staff at FFLC is to take the Ankle and Foot films in these cases. The reason is that most ankle sprains are just that, sprains of ankle ligaments. BUT foot fractures due to twisting of the ankle is more common than ankle fractures.
- Fifth metatarsal base fractures
5th metatarsal base fracture Surgical fix with screw.
- Anterior process calcaneal fractures
- Jones' Fractures.
- Lis Franc's fracture / dislocations
Tuesday, August 19, 2014
Monday, August 18, 2014
|Silver retractor points at the Peroneus Longus tendon that is scarred to wall of heel bone. Brass colored retractor on the Peroneus Brevis tendon, notice the bulbus tear just to the right of the retractor.|
|Notice the tear of the Peroneus Brevis tendon with a bone (peroneal tubercle wedged between the tendon)|
|Same issue as above with instrument pointing at the peroneus brevis tear.|
Monday, August 11, 2014
1) Soak in warm / hot water without scolding your skin
2) Seek medical attention for xrays and possible extraction under local or general anesthesia
3) Retrieval of barb by a medical professional
4) Antibiotics as a precaution.
Best way to treat this? Do not get close to the barbs with your hands or your feet. FFLC treats these injuries on an emergent basis with in office xrays, and ability to clean the wound and retrieve the barb from your foot or lower leg. At times admission to hospital to get general anesthesia may be required.
Thursday, August 7, 2014
- 75 % of american buy shoes too small for themselves imagine their children?
- Need at least 1/2 inch or a thumb's width between the longest toe to the end of the shoe while the child is standing
- Running shoes are not recommended for everyday usage for walking and activities. Running shoes are meant to be light for competition, not deal with the punishment of everyday walking and grueling activities.
- Wrong shoes are the major reason for pediatric heel / achilles and knee pain.
- Get you child's feet measured at least once a year professionally by a podiatrist , pedorthist, or qualified shoe salesman
- The shoe measuring instrument, brannock device, is meant to be used while standing, not sitting.
- Width of the shoe is as important as the length of the shoe.
- Painful flat feet? Need to see a podiatrist ASAP before other symptoms start.
Wednesday, August 6, 2014
There are various ways to treat this deformity from stents such as the hypocure to bone fusions, bone slides, reconstructions, etc.
Below are videos of a single arthrodesis to the triple arthrodesis. Arthrodesis or fusion is the mending or bringing together two or more bones. Set it and forget it as Ronco used to say. Fusions are typically for more advanced disease such as grade III or IV or if the patient is overweight with grade II disease.
Grade I : Tendonitis
Grade II: Tendonitis / Tearing
Grade III: Flexible adult flat foot
Grade IV: Rigid adult acquired flat foot
Peroneal Subluxation Syndrome.
- Does your ankle pop on the "outside" during certain movements?
- Pain on the outside of the ankle?
- Unstable ankle, feeling of about to fall off the ankle
- Burning pain outside the ankle.
- Audible popping sound when you are rolling your ankle around.
- Visually see your tendon on the outside rolling and popping?
Tuesday, August 5, 2014
Not all achilles ruptures require surgery.
Some patients do well with casting and Platelet Rich Plasma injections. See the difference in this video.
One important fact about this process is that it works best when we get the patient early in the rupture, when the tendon has not retracted up the leg.
Sunday, August 3, 2014
When in doubt biopsy it out, it can save a life.
Another leg and life saved at the Family Foot & Leg Center, PA.
How do you get a blood clot in the ankle /calf. One way is sitting still on a flight or any situation for along time with blood pooling in the legs, the blood then clots in deep leg veins causing swelling due to the blood not being able to return to the heart. When a clot breaks off and does return, it is lodged in a pulmonary vessel causing difficulty in oxygen exchange in the lung tissues. Depending on the location and size of the clot this could cause some serious damage leading to death.
Being overweight and inactive, being on birth control pills, being immobilized after an injury in cast, being immobile while on a long flight or drive, genetic clotting disorder, smoking, family history of blood clots etc. Any combination of the above can be a recipe for disaster. If you are having surgery of the lower extremity and have any of the risk factors above or combination of such, notify your surgeon ahead of time where proper tests can be done as well as proper post operative protocols can be done to help prevent most blood clotting situations, nothing is 100% in medicine. I have seen people with bunion surgery go onto having these clots.
Symptoms include: swelling of legs, coughing, radiating pain to the arm / chest, deep pain in one or both legs with swelling, severe varicose veins, redness of the leg (s), difficulty breathing, feeling tired / light headedness, looking pale / clammy or discolored skin, rapid / irregular beating heart etc.
Mayo clinic information
NIH Source on pulmonary embolism.
Disclaimer: as of this writing, I do not have the official report of his death, only information out there at this time is death due to blood clot in his ankle. This is the most common way you can die from a blood clot originating in the ankle, him being a star from American Idol probably travels a great deal on airplanes and sitting still for long periods of time between performances.
Tuesday, July 29, 2014
Possible treatments can involve a below knee or above knee amputation depending on spread of this disease.
Wednesday, July 23, 2014
Heel Pain is the most common problem seen by #podiatrist, not even the president is immune.
NaplesPodiatrist.com this is one of the most common none surgical problem that we see.
A few reasons why:
1) We are poorly educated about shoes by the media and pop culture. What is cool is not the best for you.
2) Lack of flexibility and stretching of achilles. Even in martial arts schools, running teams, they neglect this area of the body. Achilles is the biggest tendon in the body!
3) Weight, though not President Obama's issue, this does weigh heavily in why we are seeing so many heel pain patients. Want to know more about heel pain or stretching visit:
Naples Heel Pain Page
I still hear from some patients that they have no idea where to turn for pediatric flat foot / flatfeet advice. The video above is a great resource as well as the videos below highlighting the problems kids go through with their feet. Not all pediatric flat foot deformities are surgical cases. In fact, most are treated conservatively. But true surgical cases must be managed by those with extensive experience and training for such. Here is link to a flow chart as recommend treatment protocols by the American College of Foot & Ankle Surgeons.
Eat your veggies, keep a healthy weight, lifestyle, don't smoke, drink in moderation all the stuff your grandmother would tell you.
Tuesday, July 22, 2014
Red: is the Haglund's deformity AKA pump bump, common in old fashion days when pumps were popular and the back the pump rubs against the back of the heel bone.
Orange arrow: points to the spur within the achilles tendon. As you can see there is a shadow of the achilles noted in the back of the heel bone. It is also very inflammed in nature as noted with the thickness noted in this xray. MRI's are more telling of the actual tendon inflammation, injury and likely partial tears of the achilles. By the time a patient presents to me with these xray findings they have been having pain for some time already.
Not all patients with these xray findings will require surgery. Conservative care with anti inflammatories, physical therapy, shockwave therapy, massage therapy can help the condition, but if the pain persists beyond conservative care, surgical care will be required.
Below shows an xray of the same patient 2 weeks post operatively.
Notice the two noted spurs have been removed and staples in place for skin closure.
No pain at the 2 weeks mark and able to stand on the foot, not walk yet, but can stand. Will allow range of motion at 4 weeks, then therapy and a boot to be used at 6 wks. 7/22/2014, stay tuned /subscribe for updates as the patient heals from her successful surgery.
It is the facility such as the hospital or surgery center, that cost can be as high as 10 times your surgeon's fees. With all this talk about cost savings and need for medicare and patients to save money the trend is towards office based surgery suites. They are based out of the surgeon's office and is certified by the state department of health. This significantly brings down the cost of surgery procedures by eliminating the highest cost in the equation for surgical procedures. This allows the surgeon /physician to control the cost of the extraneous expenses and the patient gets the best value. You still get the same care, anesthesia, etc, but at a fraction of the cost. The one big barrier to this model of care is that when implants are being used, such as screws, wires, joints, insurance companies are not paying the office suites for these thus possibly passing the cost to the patient. In most cases even if the cost of implants are forwarded to the patient, office based suites still is a great value vs other facilities. As our healthcare system goes through these changes we should see more OBS sites.
Tore some ankle ligament? This is a story of an active male that had lateral ankle ligament reconstruction elsewhere and is here for a 3rd opinion.
Problem: wound would not close and drains as well as continued unstable ankle.
How solved: removed all prior internal stitches (fiberwire) none absorbable that were used for the ligament repair. Flushed / power washed the site with 300 liters of pressurized saline to clean any bacteria out. Sent patient to infectious disease for powerful intravenous antibiotics for 6 weeks. Repair with none braided smooth and absorbable antibacterial suture with amniotic tissue graft used for reinforcement due infected tissue that had to be removed.
Discussion: Infections happen even in the most skilled hands and seemingly sterile environments. Microbes are all over the place. I have steered away from certain braided none absorbable sutures now due to increase incidence of bacterial colonization. Braids can hide bacteria better & also presents a barrier for antibiotics to get through. Lateral ankle ligament reconstruction is not very difficult to do, most patients have enough of their own tissue nearby that can be rotated to reconstruct ligaments.
Can not believe it is back to school shopping again for SouthWest Florida Schools.
Let us look at the proper way to assess and buy shoes for your child to avoid foot , heel, or ankle pain.
Many of the problems we see in kids can be avoided with the proper fitting shoes and proper length.
Having a child that is in his growth spurt, I know it can be challenging in keeping up the size of shoes in kids.
Timeline for replacement can be anywhere from 3 months to 6 months depending on activity of the child, weight, etc.
Wednesday, July 16, 2014
Frank discussion about ankle fusion and this technique to achieve such.
Fusion of the ankle can be complicated and difficult to heal from with up to 50% nonunion rates (failed fusion) depending on technique. Arthroscopic fusion is greater than 90% fusion rate according to studies mostly from lack of dissection, keeping nerves and blood supplied intact and mostly the anatomy also is intact during this type of fusion.
With the advent of percutaneous intermedullary rods and external fixation techniques most ankle fusions do not need to be opened.
Tuesday, July 15, 2014
- Air out your shoes / socks, do not keep them on too long if you happen to step on a puddle
- Dry / scaling feet or cracks between the toes, smelly, time to see your podiatrist
- Diabetics with redness or cracks in the feet must see a doctor or risk infections and amputations
- Rotate your shoes have at least 2 pairs to alternate daily humidity and wet weather is a great breeding ground for fungi
- As a preventative, you can use baby powder or foot powder between your toes every day to keep the sweat from becoming a problem.
Monday, July 14, 2014
5 Things you want to know about Methicillin Resistant Staph Aureus.
1) Staph Aureus is all around us, on our skin, desktops, phones, etc. MRSA is just a variant of this bacteria that is resistant to methicillin a form of beta-lactam antibiotic aka penicillin family.
2) MRSA starts out as a bump on the skin / boil, blister, etc.
3) Can go deeper through the skin to the fat, muscles and blood where it can be deadly
4) Only way to identify is through cultures taken at the doctor's office or hospital. In fact, most patients in the high risk category such as immunocompromised or diabetics, that are admitted to hospitals nowadays are assumed MRSA infection until otherwise noted
5) There are newer oral antibiotics that are effectively treating MRSA, IV antibiotics is still the quickest way to get the antibiotics into your system for limb or life threatening situations.
5 ways to avoid or pre diagnose MRSA
1) Nasal Nares cultures: taking a culture of the nasal passages can determine if the person is a carrier and if so a regimen if antibiotic application and bathing in selective solutions can help
2) Wash your hands frequently, and use hand sanitizers.
3) Make sure you wipe down and pre-wipe all equipment at the gyms
4) Jujitsu or karate uniforms must be clean at all times, jujitsu more so then karate. No badge of honor for sticky yellow uniform that is supposed to be white. Use long rashguards to avoid skin abrasions.
5) Mats or other contact surfaces must be cleaned and disinfected with anti MRSA solutions.
When you have a skin rash, infection, make sure a culture is taken and empiric (broad spectrum) antibiotics are started immediately, can be a matter of limb and life loss.
Remember Kevin Randleman's Staph infection? Vinny Magalhaes had to step out of Metamoris 3 lineup due to this infection.
Not to say, do not practice contact sports for I love Brazilian Jujitsu and Karate, you and the gym should take precautions against MRSA. As a medical student and even as a resident back in late 1990's, MRSA was not as common. How does this happen, where and when did this happen that MRSA is so common?
One big blame is the overuse of common antibiotics like penicillins, bacteria generations are way shorter then humans and through true Darwinian concepts, one bacteria forms resistance and thrives while others are killed. The overuse of antibiotics is one major cause. We actually need bacteria on our skin to keep a balance as well as bacteria in our gut for proper food digestion, not all bacterias are bad.
Hospitals , nursing homes and jails are big source of community acquired MRSA due to both population density and antibiotic usage.
Dr. Kevin Lam
Tuesday, July 8, 2014
Monday, July 7, 2014
- Severs Disease inflammation of the heel growth plate. I see this in basketball players and karate students. Best way to treat this at home is to do achilles stretching, wear proper shoes and heel cups. If these fail, then a visit to your local podiatrist would be in order. Below is a film about stretching, for more resources, visit www.Naplesheelpain.com
- Os Vesalium Syndrome: Swelling and pain the base or back of the #5 metatarsal base (bone on the outside of the foot. Stretching, rest, Ice.
- OsGood Schlatter disease: Pain in front of the knee where the patellar tendon inserts into the tibia. Patients will complain about knee pain typically in the 10-15 year old age group. Stretching the hamstrings and quads will help this condition as well as Rest, Ice, and topical anti inflammatories.
- Second most common foot pain in a child of this group is Os Vesalium syndrome.
Steps you can take to control, avoid such
- spray your shoes / sandals with lysol and allow to air for 24 hours, also alternate shoes, sandals
- if you sweat a lot, use antifungal foot powder spray to keep odor and fungus at bay
- wash socks in color safe bleach
- do not wear wet shoes! Dry them out completely before wearing
- pay attention to between your toes, toe jam = dead tissue that can be a breeding ground for fungus
Sunday, July 6, 2014
When a fighter throws a roundhouse kick or a spinning kick there is a lot of circular force going through the support leg and toes. Typically the toes will fan out to act as disc brakes and help to control the fighter's momentum and balance. This is where the bunion joint is stuck and the second toe takes way too much lateral force as the person is spinning. Treatment for an exposed bone in any situation would be treated as if the patient has osteomyelitis, it is assumed a bone infection. Whenever a bone is exposed to air or touches an object it also assumed infected. Most likely treatment in this case will be 6 weeks of intravenous antibiotics, surgical flushing and closure of the second toe with possible pinning, his career will not be in jeopardy for this warrior. He will not be fighting or training anytime soon at least within the next 6 weeks with this kind of injury. I certainly hope he will read my blog about minimally invasive bunionectiomies and get that taken care of during this medical leave.
Friday, July 4, 2014
The arteries first will stiffen, then plague will form within the wall of the artery to cause narrowing, the narrow passageway of blood becomes more a problem below the knees when the arteries narrow and gets narrower quickly into the foot.
Below is a clinical picture of dead toes just prior to scheduling amputation. Symptoms are uncontrollable pain , cold feet and lack of warmth in the feet.
Patient lost 3/4 of his foot to smoking, diabetes, etc. Patient requested amputation vs trying to save the foot utilizing hyberbaric oxygen treatment as an option.
239 430 3668