Snow Bird Season in #SWFL starts October

It is that time again where our northern friends return to enjoy our beautiful weather.   A few tips, when you are driving down, please make several stops and walk around to prevent deep venous thrombosis or clotting of the veins that can be deadly if progresses to the lungs.
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

Central Scheduling:
Call: 239 430 3668
Fax: 239 692 9436

Jon Bon Jovi has heel pain relieved with endoscopic release

For the past three decades, Jon Bon Jovi has been performing concerts all over the world in front of millions of loyal fans. What those fans did not realize was that he was pushing through intense foot pain for many of those concerts. “The pain was so severe during my 2013 Because We Can Tour that I would want to jump through the ceiling whenever it was touched,” Jon says. “I got to the point where I was given injection therapy, orthotics, shockwave therapy, and platelet rich plasma (PRP) therapy, but they did not alleviate the chronic condition.” After the tour concluded, Jon revisited John Connors, DPM, a sports podiatrist at Riverview Medical Center.


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.

Back Pack Tips for Back to School

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:

Stress fractures Inflammation of growth cartilage Back and neck strain Nerve damage in neck and shoulders Low back pain

Look at it this way – carrying a 12–pound backpack to and from school and lifting it ten times a day for a school year puts a cumulative load on a child’s body of 21,600 pounds – the weight of 6 mid–sized cars!

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:

A child’s backpack should weigh no more than 10% of his or her weight. Choose a pack that ends above the waist and that has padded, adjustable straps; always wear both straps. Carry only what is necessary. Consider a backpack that has rolling wheels if permitted in your child’s school.

Joan Rivers and outpatient surgery environment, shouldn't be done?

The death of a comedic icon, Joan Rivers is unfortunate and has shed a spotlight on the topic surgical settings. 

Reality is that mortality, death, can happen even in the most minor of procedures either in the hospital , office based surgery or the ambulatory surgery outpatient setting.    The regulations in place for all outpatient surgery requiring anesthetics of any kind that is more than local anesthesia (commonly referred to as novacaine)  is very strict by various state laws.  

Due to insurance and government's efforts to control costs more procedures are going outpatient to the latter two of the facilities.   Cost savings are enormous for the government, insurance carriers and to patients.   

Hospitals usually charge and receive up to 3 times the reimbursement for the same procedures done at outpatient facilities while doctors are paid similar regardless of facilities chosen. 

The question that was brought up recently was safety, is it safe? 

Yes, the outpatient facilities are just as safe as hospitals and are under tighter scrutiny, just ask the administrators of those outpatient facilities.   If sedation or general anesthetics are used the surgeon as well as the anesthesiologist are both required to be certified by American Heart Association in Advanced Cardiac Life Support.     The same doctors responsible for life saving actions in the hospitals are present during outpatient surgeries as well as same drugs. 

The media seems to spin things out of proportion for ratings.    The outpatient facilities tend to deal with cleaner cases which also tends to lower infection rates vs hospital setting.  This is a big plus for patients.    Hospital acquired infections are less common in the outpatient setting as there are no long term patients undergoing dirty procedures such as a perforated bowel, MRSA wound washouts, etc.

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.

Foot Fractures more common during "ankle sprains."

"Doc I sprained my ankle and it has been hurting for the last month,the ER says my ankle is not broken," the patient.  

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

I know the last one personally. I twisted my foot during Brazilian Jujitsu practice and immediately my foot and ankle swelled up.   Being a foot / ankle doctor, the treatment that night consisted of ICE, rest and ace wrap, the next morning Xrays were taken.  Luckily, no fractures but I did have a lis franc's sprain which has taken up to 6 months to get me back to 90 % of my physical activity.    

So when you think of ankle sprains now, think, check the foot!

Worker's compensation and Motor Vehicle Accidents of the Foot / Ankle

Often the difficulty comes from a patient waiting too long to seek medical attention or they do not tell all their complaints to their treating doctor.   They can be concentrating only on one area of the body, eg: shoulder / back pain but forget about the ankle injury and thinks that it is only a sprain.  There are times when clinicians can get tunnel visioned in treating one area of significant injury but inadvertently do not address another area. Being trained in trauma surgery and reconstructive surgery, I have seen the neglected ankle sprain being a tendon rupture / ligament rupture, nerve damage, etc.     MRI's and through physical exam by a specialist physician are very useful around the time of the injury to see active swelling, injury to the tissues in question.   This can help to answer the age old question of if this a new injury from this accident or a preexisting injury or even an aggravation of a preexisting condition.    

If you need a second opinion after any accident about your foot / ankle concerns seek a board certified expert with experience in trauma care and reconstruction. Independent medical examinations (I.M.E.) can be done to help also.

Life altering ankle sprain why you should see a doctor.

Hint: NOT AN ANKLE SPRAIN but ligaments and tendon ruptures

Active tennis coach who took a wrong step and twisted his ankle on the court while teaching about 4 months ago, ankle never felt better and in fact worsened and also feels unstable on this ankle.   Pain, burning sensation noted about the outside ankle bone.   MRI notes tears in both tendons on the outside as well as 2 ligament tears.  There are 3 ligaments on the outside of the ankle the Anterior TaloFibular Ligament (ATFL), Calcaneal Fibular Ligament (CFL) and the Posterior TaloFibular Ligament (PTFL) as well as 2 tendons the Peroneus Brevis and the Peroneus Longus tendon. 

Most people will shrug off an ankle twist and think that if they can still put weight on the foot, they are fine, just a sprain.   This is just one of the complications of a neglected "ankle sprain."      In fact, often ankle fracture are less painful than a ligament tear.    There are also discussions with new imaging technology that even those injuries classified as sprains are actually mini ruptures of the ankle ligaments.   Repeated injury can cause lengthening of the ligaments and predispose a person to more injury in the future if significant injury has not already been done. 

Back to this case:  This person injured tore two of the 3 lateral ankle ligaments, then the two tendons were injured in the same accident.  Bracing and therapy would not help in this situation though was suggested by the insurance company and the independant far from caring reviewing orthopedic surgeon hired by the insurance company to deny MRI's and surgeries.   Orthopedic surgeon or podiatrists are hired to do reviews of these cases to first deny MRI's and then to deny surgeries.   Acting as a patient advocate in this case and many calls made, finally an MRI and surgery was done, the orthopedic surgeon's callus opinion was overturned by a case manager. 

Surgery involved arthroscopy of the ankle joint to assess the cartilage and remove any inflammed tissue in the ankle, patient did have an anterior lateral impingement syndrome that was cleared with arthroscopic tools through a 4mm portal.  Both tendons repaired, bone removed from the outside of the heel bone, the peroneal tubercle is a natural occurring structure but in this case worsened his situation.   New ankle ligaments were made for this patient with his native tissue, yes, we can make new ankle ligaments. 

Updates to follow: 

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.