Adult flat foot repair with implant

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. 

right foot after implant / stent notice the arch

Notice left foot flattening

Lump on back of the heel: Haglund's deformity, Achilles tendonitis, Tendonosis

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

Symptoms:

Burning in the achilles, unable to run, jump or wear shoes due to the rubbing of the achilles. 

Throbs

Tightness in the Achilles

Conservative treatments:

See 1) NSAIDS such as motrin, etc if tolerated

2) Physical therapy

3) Home stretching excercises

4) Ice

5) Avoid shoes that rub on that area. 

6) High Energy Shockwave therapy

7) Platelet Injections / Stem Cell therapy

Diagnostic tests:

• MRI will likely show degeneration, partial tears or chronic inflammation, value of such is questionable. 
• Xrays are great for seeing the bony deformity that is causing this condition and surgical planning. 

Surgical treatment:

• Removing of the Bump 
• Removing of any spurs as indicated. 
• Removing inflammed or damaged achilles tendon
• Repair of the Achilles back into the insertion.

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. 

Patient is an active runner, pain immediately subsided after surgery. 

"Bump" no longer visible or irritated. 

4 wks in a cast, then another 2 wks in a boot that he can remove to start range of motion excercises. 

Physical therapy and boot to be used for walking at 6 weeks. 

Tens unit can be used to help with the cast disease that develops from not using the limb for some time. 

Overall, this is a very simple surgery to correct the condition.  Technique chosen by your surgeon varies.    I personally prefers to keep the achilles attachment and remove the spurs from varying angles to avoid prolonged recovery.  This also allows for anatomical repair without a question as to where mother nature intended. 

FFLC taking new patients

239 430 3668 option 2 for scheduling or you can request online through our PATIENT PORTAL. 

Bump on bottom foot aka plantar fibroma

Plantar Fibroma treated with conservative care at first at our center without avail.   Initial treatment consists of topical gel of Verapamil 15% gel and other topical compounds to help relieve the pressure and pain in an attempt to reduce the size but was to no avail. Typical protocol is 3 x a day application up to  9 months even.   She was not able to continue conservative care due to pain with every step. 

How are they formed? 

No true answer to this. Theories have involved: microtrauma, genetic predisposition, that causes the body to form extra fibrous tissue. 

Where are the fibroma commonly located in the foot? 

Typically the medial to central band of the plantar fascia. 

Medial being the side towards your big toe and central being around the 2nd and 3rd to region.  The photos below is a classic example of the fibroma in the medial and central bands. 

What are the chance of regrowth and is surgery successful? 

Fibromas have a high recurrence rate, up to 80% in some papers.    

Recommendation is usually to only remove such only if symptomatic. 

Symptoms can occur with even very small fibromas, some patients with even huge fibromas do not hurt. From experience the patients that complain about pain are those that have the fibroma growing right over a nerve, often an inflammed nerve is found under this fibroma.   The best case scenario is no regrowth or recurrence but next best out come is that if the fibroma regrows it forms in a different area that does not compress on the nerve. 

What steps can my doctor take to improve success? 

Papers have stated up to a 1.5 cm margin of regular tissue to be taken out in addition to the fibroma itself to reduce the chances of recurrence. 

I have them on my hands and my feet is that normal? 

Some people do have it in both areas but not always.  A hand surgeon or plastic surgeon will help address the hand lesions.  You have the same band of tissue called the aponeurosis in the hand as well as the foot. 

If you or loved ones have this condition call us at 239 430 3668 option 2 to schedule an appt!

Preop from the side of the Fibroma

Bottom look at the fibroma, see the dark area
 due to rubbing of the fibroma in her shoes. 

z incision made for adequate exposure for removal

Note the lesion with viable margins also removed
 to help  prevent regrowth

What You Want to Know About Ankle Arthritis

According to the Mayo Clinic:
The two main types of arthritis — osteoarthritis and rheumatoid arthritis — damage joints in different ways.
Osteoarthritis
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.
Rheumatoid arthritis
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.

I will concentrate on the osteoarthritis particularly in the ankle.  Most common complaint from a patient coming into the office:   pain , stiffness in the morning and relieves slightly after walking as well as swelling in the ankle.    Most will have history of ankle sprains or even a severe ankle fracture in the past. 

Did you know that even "mild" ankle fractures or sprains can lead to arthritis?  Ankle injuries can lead to OCD or osteochondral defects in the talus bone.    Translated: Pothole in the talus, the bone that connects to the ankle joint.  Will leave this for another blog to discuss treatment. 

Ankle arthritis or synovitis is inflammation of the ankle cartilage, joint inflammation from a variety of causes.    

Treatments: 

• 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

FFLC surgeons and physicians are well versed in treatment of this condition. 

Top technology and experience for this condition. 

Call 230 430 3668 for appt

Check out our various youtube videos discussing this disease. 

Lump on the top of the foot aka Ganglion Cyst of foot

Often, patients come into my office with a complaint of having a lump on the top of the foot. Sometimes they are referred here promptly from their primary care physician with concerned about this lump for possibility of cancer. The reality is that most of these lesions on the top of the foot happens to be a benign ganglion cyst.   

What is a ganglion cyst?

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. 

Family Foot & Leg Center, we keep you walking and treat these bumps with ease. 

239 430 3668  option #2. 

Additional information from the American College of Foot and Ankle Surgeon about ganglion cyst below.

Ganglion Cyst

What Is a Ganglion Cyst?A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin.

Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.

CausesAlthough the exact cause of ganglion cysts is unknown, they may arise from trauma – whether a single event or repetitive micro-trauma.

SymptomsA ganglion cyst is associated with one or more of the following symptoms:

• 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

DiagnosisTo diagnose a ganglion cyst, the foot and ankle surgeon will perform a thorough examination of the foot. The lump will be visually apparent and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases additional imaging studies may be ordered.

Non-Surgical TreatmentThere are various options for treating a ganglion cyst on the foot:

• 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.

When is Surgery Needed?When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns.


FFLC treats these and other foot / ankle ailments with ease. Call: 239 430 3668 option 2. 

Passing on your foot problems to your kids

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.

Continuing education a way of Life

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.