Dr. Kevin Lam Naples Top Podiatrist on the Rise to the Top

• How you got started?

Started when I visited my current mentor Dr. Stephen A Monaco in Havertown, PA as a college student. As a biochemistry / microbiology major the possibilties  were endless.   As a high school student I was exposed to Osteopathic Medicine and the holistic approach to wellness during my 2 years at the Pennsylvania School of Osteopathic Medicine in Philadelphia as a medical explorer.  Always in the back of my mind, D.O. was my path for my future.   The premedical club at my university had a tour of Temple University School of Podiatric Medicine, I figured I would attend and explore for up until this part of my education I had no idea what Podiatry was and now the rest is history after being accepted for admission as the youngest student to matriculate that year after 3 year of undergraduate work. 

• How you work?

Always like being on the cutting edge in the field.    As a resident in training I always gravitated towards the more difficult cases.    The ability to transform someone's life by realigning their foundation either via orthotic therapy, padding or surgery is very gratifying.     Protocols are set in the office to give patients the optimal care, for those that don't respond to our typical protocols advanced testing /imaging can be done for more aggressive care.     Conservative care will always be an option that is explored and exhausted prior to surgery.    

• Teach with a lesson—using rich, authentic stories?

Always giving the patient the correct advice , thorough picture of their condition. Sometimes the correct solution may not be the easiest solution.  I had a patient that required a severe bunionectomy at the base of the bone rather then the regular type at the head of the bone, this required 6 wks off the foot to recovery.  She went to another surgeon who gave her what she wanted a simple fix with no time off her feet.    6 months later the bunion returned as did she to the office for a revision.    The moral of the story is that the simple answer may not always be the correct answer. Some surgeons / doctors will do things to appease the patient's request, hence doctoring themselves and using the doctor as a vehicle to achieve such.  My goal is to always give the Best answer whether it is difficult or not. 

•  Vision

Vision is that one day the profession of podiatry fulfills the quest to have all DPM's trained equally and have the profession as a whole recognize the true value of our services.  

• Obstacles to overcome. 

Often I hear, what would a foot / ankle orthopedic surgeon do that is different from what you propose?  Why would I have you do the surgery vs an orthopedist?   My answer is seek out the one that does most of these procedures, not the title.  Foot and ankle Orthopedist spends 1 year on the foot / ankle after orthopedic residency while reconstructive podiatrist spends 4 years in podiatric medical school building a strong foundation in biomechanics and foot medicine, then 3 years of surgical residency with concentration on the foot / ankle and now many are going for a 1 year fellowship after such for a total of 4 years of concentrated foot /ankle surgery concentration.     Both professions have great doctors and some not so great ones.     Choose based on reputation , # cases and not the initials would be my best advice.    Check with hospital OR nurses, etc to ask who does more foot / ankle surgeries and who is most successful at them.    Anesthesiologists see the good, bad and ugly in the OR, they can give you an excellent recommendation if you happen to know one.     

Avoid amputation as a diabetic

Diabetes remains the most common reason for nontraumatic amputation in the USA.    Diabetic amputations and complications from diabetes kills more people then some cancers.   5 year mortality rate after a leg amputation is depressing at close to 50% in some studies.    People don't realise this until it is way too late.
If you have been diagnosed with diabetes  you must see a podiatrist on a regular basis as well as do daily foot checks by yourself or a family member.  

Few reasons why diabetics are at high risk for foot problems.

1. "Lazy immune cells"  can't fight off infection as efficiently
2. Lack of feeling on the bottom of the feet, you can't feel if you have a blister or ulcer that would stop most people to check.
3. Peripheral arterial disease (PAD): diabetics tend to have higher rate of arterial insufficiency or decrease in blood flow.  That lack of blood flow inhibits healing of the wound. 
4. Glycosylation of muscle, sugar coating muscle cells causing stiffness of the calf muscle and cause contractures. Same way a hemoglobin can be sugar coated hence the HBA1C test that is done to assess diabetic control. 

Ways to increase your odds of keeping your toes, feet, legs.

1. Keeping your HBA1C  around 5.7
2. Maintain healthy weight
3. Visit a DPM every 6 months for low risk or every 3 months for moderate to high risk. 
4. Always get fitted for shoes, measured by your podiatrist or pedorthist do not wear open toed shoes. 

Some diabetic amputations are preventable with proper preventative care and observation by a podiatrist. 

Save your limb or a loved one's. 

One major reason for diabetic amputation is diabetic polyneuropathy.  There is research from Dr. Dellon of John Hopkins Medical Center that explains one of the causes of diabetic polyneuropathy is caused by the compression of the nerve.    Theory explains that when a metabolite of sugar, sorbitol is abundant around a nerve, this causes the nerve to swell, initial symptoms are numbness, then can progress to pain as the nerve disease progresses.  Tests that can be done to evaluate this or to rule out other nerve compressions as a root cause are the following: nerve conduction studies and EMG, nerve biopsies. cutaneous nerve biopsies, nerve blocks, etc.    Typically neuropathy will start with tingling, numbness, can later progress to severe pain such as pins and needles.   Treatments include vitamin supplementation, nerve medications such as lyrica or neurontin, cymbalta, etc. , physical therapy, nerve stimulation via TENS unit.   Latest treatment combines the nerve stimulation along with nerve blocks to help re ignite the nerves to decrease pain and discomfort associated with neuropathy. Results have been staggering:

As you can see from above at visit / treatment #14 the pain scale goes from a 10 to less then a 1.   This is an awesome result given that up until now there have been very little choice besides medications.

Dr. Kevin Lam
www.NaplesPodiatrist.com

diabetic testing diabetic testing strips

Severe Bunion travels 150 miles to Naples, FL for Surgery

Before the bunionectomy, note large Bump on the Bunion

1 wk after surgery with the toe in position and wire

At about 8 weeks patient is in sneakers & regular activities. 

There is no reason to wait for your minimally invasive bunionectomy.  This can be done in the office safely under local anesthesia or in outpatient hospital setting under sedation and local anesthesia.

1. Can be used for serious bunions such as above
2. Minimal Pain to no pain. 
3. Walk immediately after surgery in a boot.
4. Less risk of infection or complication due to 5mm incision
5. Office or Outpatient hospital Surgery
6. Can be used for revisional surgery
7. Very minimal complication rates
8. Virtually scarless. 

Revisional Bunion Surgery via Minimally Invasive Technique

Patient had bunionectomy 20 + years ago. You can see the preop right foot.   During recovery and fully recovered.   You will note that the screw was removed and the angular deformity has been corrected. 

Guess who's coming back for the left foot revision? 

This modification of the Peabody bunionectomy not only is good for initial bunion surgery but also for revisions.     

Get more information at: ScarlessBunion.com

Bunion AKA Hallux AbductoValgus Vs Arthritic First Toe Joint or Hallux Rigidus

Just a Bunion or Arthritis of the big toe

Most people think they are the same.  Below is an Xray of the same patient.  One  on the left is a bunion, note the joint space present in the big toe joint as shown by the arrows.    On the right, you will notice no joint space.      As you can see, visiting a podiatrist is very important to figure out the difference.  On the outside they both look the same with the bump on the outside of the foot.   Xrays will show the difference and help to guide treatment options.   For true bunions visit my site about the scarless bunionectomy. 

Arthritic joints if not angulated like in this picture, a joint implant may be useful.   But severe angulations like this will require fusion of the toe for best results.

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