Don't go to a Cardiologist for Foot Care.

May sound ludicrous and far fetched to associate cardiology with foot care.   But the general public, fellow physicians: MD and DO's do not know a well  hidden secret of podiatric medicine.   There are actually sub categories of podiatrists.  The profession of podiatry on one end has advanced,  very highly specialized surgical profession that can do ankle implants and leg lengthening procedures, but on the other end, a majority of our profession does not acknowledge the skills and specialization that our profession has pushed so hard to gain.   For instance when a local podiatrist can not do a midfoot fusion or ankle fusion and would refer you to an orthopedic foot and ankle surgeon for he/she does not do these surgeries.  This incorrectly infers that all podiatrists do not do these kinds of surgery.   This has more to do with competition, egos then proper care for the patient.   Secret:   900 podiatrists in the US ( DPM's) have the designation as Reconstructive, Rearfoot / Ankle surgeons by the American Board of Podiatric Surgery.      This designation is recognized by Orthopedic Foot and Ankle Surgeons but not by our own colleagues.    So don't go to a foot surgeon when you need a reconstructive rearfoot / ankle surgeon.  It is almost akin to going to a cardiologist for foot care.     Unfortunately,  it is difficult even for DPM's to figure out who has this designation,  and it is done to the detriment of patient care.   Dr. Kevin Lam is currently the only one in Collier County who is Board Certified by the American Board of Podiatric Surgery in Reconstructive RearFoot and Ankle Surgery.   Dr. Timm will be next.

I often hear, Oh I didn't know you were here.  I have been to 3 podiatrists in town and they all referred me to the next town for my reconstructive surgery.    Unfortunately, some find out about our clinic after they have had surgery and now require revisional surgery.   When choosing a podiatrist or orthopedist for your foot / ankle surgery, chose the one with the most experience with your condition, not one with the best looking initials after their name.

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.
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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