RECONSTRUCTIVE SURGERY

Occasionally, all conservative treatment fails, and we rely on surgical intervention to treat more complex foot and ankle deformities. Dr. Sekulic is Fellowship trained in Reconstructive surgery and provides patients with a comprehensive pre-operative evaluation.

Bunions

Bunions are deformities that are visible at the great toe joint (see pic) There are variable levels of bunion deformities. Not all bunion deformities are painful. However, if the bunion is severe, measures taken to prevent progression of the bunion is highly recommended.

Undoctored Treatment

Accommodative shoe gear, bunion strapping, or custom orthotics can prevent the progression of a bunion deformity. Modify your activities to minimize bunion discomfort. Avoid tight fitting shoe gear with narrow toe boxes. I recommend finding athletic shoes with wide toe boxes (i.e Altras).

Medical Treatment

X-rays are always taken during your initial consult. Measuring radiographic angles are critical when evaluating the severity of a bunion (see pic). Painful bunions are more problematic, and generally involve surgical correction. The apex of the bunion deformity occurs at the first metatarsal cuneiform joint (see pic). When evaluating bunions, the first metatarsal cuneiform joint is checked for increased laxity and may need to be fused in order to correct severe bunions. In symptomatic mild bunion deformities, a metatarsal head procedure (see pic) with a possible great toe procedure (see pic) may be necessary in order to alleviate symptoms.

Degenerative Arthritis

Degenerative arthritis, also known as osteoarthritis, can occur in any joint in your foot or ankle. This condition occurs when the cartilage surfaces of the joint start to wear away, and the underlying bone starts to grind against the opposing surface. This results in varied levels of pain and immobilization. Regardless of what joint in the foot or ankle is affected, treatment protocols are based off level of pain, and activity goals.

Undoctored Treatment

Determine your level of pain and tailor your activities to minimize the pain. Since osteoarthritis can be progressive, pushing through your pain can cause further cartilage damage. Stiff soled shoes or ankle bracing can limit joint motion and hence prevent further wear and tear on the affected joints. With limited motion, pain tends to decrease. Ice after activities to alleviate pain and swelling.

Medical Treatment

Often times a medical grade over the counter orthotics, or a custom orthotic can help manage symptoms and inhibit or delay the progression of the arthritis. We offer regenerative Stem Cell therapy to restore cartilage. SUPARTZ FX is a hydroluronic acid substitute which gives synovial fluid its elastic properties. It inhibits further cartilage breakdown and decreases pain. Follow this link to learn more.

Corticosteroid injections can serve as diagnostic as well as therapeutic treatment options. The injections are performed under ultrasound guidance for improved accuracy. Corticosteroid injections offer varied levels of pain relief. Typically the injections are provided to buy the patient months or even years of time before undergoing a joint fusion.

For the less progressive forms of degenerative arthritis, a surgical procedure that just involves cleaning up the joint or removing spurs that surround the joint can offer significant relief. Once again, the joint salvage procedures can buy the patient years before a joint fusion in necessary.

For the more progressive forms of degenerative arthritis, joint fusion is the gold standard for treatment. When arthritis has progresses to this point, the patient already has very limited motion of the effected joint, as well as severe pain accompanying joint range of motion. Patients report excellent results after these procedures and don’t typically notice a remarkable change in their gait, given that they had such limited range of motion to begin with. Accommodative shoe gear and orthotics are always recommended after a joint fusion to assist in gait function, as well as prevent the degradation of adjacent joints.

Hammertoe

A hammertoe is a contracture deformity of the toe that occur secondary to imbalances between the small and large muscular of the foot. There are two joints in each toe, and the contracture can occur at either one, or both of these joints. Hammertoes can be very painful with shoe gear. However, the toe can also be painful while the patient is barefoot.

Undoctored Treatment

Finding shoes that accommodate your deformity is paramount to alleviating pain. Make sure that your shoes are long enough in order to avoid scrunching of your toes, which will worsen your deformity. Silastic toe sleeves or other over the counter toe cushions can help to alleviate your pain.

Medical Treatment

X-rays and a gait exam will always be performed during your initial consult. If the hammertoe deformity is causing pain to the tip of the toe, a percutaneous flexor tenotomy procedure can be performed (video link or pic). This procedure is done in clinic and patients are back to full activity the next day. In cases where the hammertoes are rigidly contracted, surgical intervention may be warranted to straighten the toe.

Rheumatoid Foot

Feet that are affected by rheumatoid arthritis have a distinct clinical and radiographic appearance (pics). Patients complain of constant and severe pain localized to their forefoot, which prevents them from standing barefoot for any extended period of time. Rheumatoid arthritis can be diagnosed with various lab tests, clinical joint exams, and radiographs.

Undoctored Treatment

If you suspect that you have rheumatoid arthritis it is important to see a rheumatologist to get started on the appropriate medications. Despite foot deformities, some patient’s symptoms can be adequately managed with the appropriate rheumatoid medications. Appropriate shoe gear must be worn to accommodate foot deformities whether or not you are experiencing pain.

Medical Treatment

During your initial consult, we will discuss which rheumatoid medications you are currently taking. Accommodative shoes and custom orthotics are recommended. Corticosteroid injections are offered to alleviate joint pain and inflammation. Foot deformities and pain can be progressive. If symptoms are not improved with conservative care, a reconstructive surgery may be warranted.