Forefoot Surgery
Many foot problems do not respond to “conservative” management; Dr. Fernandez can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to help alleviate them, or to restore the function of your foot.
Bunions
A common deformity of the foot, a bunion is an enlargement of the bone and tissue around the joint of the big toe. Heredity frequently plays a role in the occurrence of bunions (especially among women), as it does in other foot conditions. When symptomatic, the tissue may become red, swollen, and inflamed, making shoe gear and walking uncomfortable and difficult. If conservative care fails to reduce these symptoms, surgical intervention may be warranted. Dr. Fernandez will determine the type of surgical procedure best suited for your deformity, based on a variety of information which may include X-rays and gait examination.
Hammertoe
A hammertoe deformity is a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toes; due to the “budding” effect of the toe(s), hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making if. difficult to wear shoes. Dr. Fernandez may suggest correction of this deformity through a surgical procedure to realign the toe(s).
Neuroma
An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma. Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling to adjacent toes and even numbness are commonly seen with this condition. If conservative treatment does not relieve the symptoms, then Dr. Fernandez will decide based on your symptoms whether surgical treatment is appropriate.
Bunionette (Tailor’s Bunion)
A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or “small bunion” is caused by a variety of conditions including heredity, faulty biomechanics (the way you walk) or trauma, to name a few, Pain is often associated with this deformity, making shoes very uncomfortable and at times even walking becomes difficult If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested. Dr. Fernandez will develop a surgical plan specific to the condition present.
Toenail Deformities
Ingrown or deformed toenail tissue may be severe enough to warrant surgical treatment. Removal of part or all the nail may be necessary, depending on the deformity. Sometimes soft tissue near or at the nail plate must be removed to adequately treat specific conditions of the toenail, Dr. Fernandez will decide the surgical procedure best suited to treat your nail condition.
Bone Spurs
A bone spur is an overgrowth of bone as a result of trauma or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur. Dr. Fernandez will determine the surgical method best suited for your condition.
Preoperative Testing and Care
As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatric surgeon will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by the podiatric physician, such as blood studies, urinalysis, EKG, X-rays, blood flow studies (to better evaluate the circulatory status of the foot/legs), and biomechanical examination. A consultation with another medical specialist is sometimes advised by Dr. Fernandez, depending on your test results or a specific medical condition.
Postoperative Care
The type of foot surgery performed determines the length and kind of aftercare required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and insure a safe recovery after foot surgery. A satisfactory recovery can be hastened by carefully following instructions from Dr. Fernandez.
Rearfoot Surgery
Many conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems an be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.
Heel Surgery
Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in both children and adults, most an be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted. Plantar fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue an become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot. Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless others may produce chronic pain. Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Dr. Fernandez will determine which method is best suited for you. There are many other causes of heel pain, which has become one of the most common foot problems reported by patients of podiatric physicians. Many of them have a basis in heredity, as do a lot of other foot conditions. Among the causes are stress fractures and stress-fracture syndrome, entrapped nerves, bruises, bursitis, arthritis (including gout), deterioration of the fat pad on the heel, improper shoes, and obesity, just to name some. Most of these conditions will be treated non-surgically, though surgery may be recommended in some instances.
Haglund’s Deformity (“pump bump”)
This deformity is characterized by a bony enlargement on the back of the heel. Although not always painful, it may become so if bursitis develops near the Achilles tendon secondary to footwear irritation. If attempts at shoe modification and other medical treatments fail to improve this condition, surgical correction may be beneficial. Based on X-ray evaluation and other tests or examinations your podiatric surgeon will select an operative treatment to alleviate the condition.
Insertional Achilles Calcification/Spur
This deformity differs from Haglund’s deformity, in that spur formation or calcification at the insertion of the Achilles tendon Is the ause of pain. Often associated with Achilles tendinitis, this deformity can often be difficult to treat medically and therefore surgical treatment may be necessary in chronic cases. There are many causes of this condition, including arthritis, but the most common appears to be overuse syndrome, where trauma occurs where the Achilles tendon attaches to the heel bone. Surgical treatment includes removal of the bone spur and/or calcification, along with repair of the Achilles tendon.
Reconstructive Surgery
Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.
Preoperative Testing and Care
As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to obtain a successful surgical outcome. Prior to surgery, Dr. Fernandez will review your medical history and medial conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status that may be ordered by Dr. Fernandez include blood studies, urinalysis, EKG, X-rays, blood flow studies (to better evaluate the circulatory status of the foot/legs), and biomechanical examination. A consultation with another medial specialist is sometimes advised, depending on your test results or a specific medical condition.
Postoperative Care
Surgery of the rearfoot requires close care following surgery. To assure a rapid and uneventful recovery, it is important to follow your podiatric surgeon’s advice and postoperative instructions carefully. Rest, ice, compression and elevation of your foot/ankle postoperatively is often advised. The usage of bandages, splints, casts, surgical shoes, crutches, or canes may be necessary after surgery. Dr. Fernandez will also determine if and when you can bear weight on an operated foot.
Ankle instability and injuries
Ankle pain is often due to an ankle sprain but can also be caused by ankle instability, arthritis, gout, tendonitis, fracture, nerve compression (tarsal tunnel syndrome), infection and poor structural alignment of the leg or foot. Ankle pain can be associated with swelling, stiffness, redness, and warmth in the involved area. The pain is often described as an intense dull ache that occurs upon weight bearing and ankle motion.
Initial treatment may consist of rest, ice, elevation, and immobilization, but may also include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, physical therapy, and cortisone injection. Dr. Fernandez can best determine the cause of the ankle pain and appropriate treatment options.
Chronic Ankle Instability
- Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the “giving way” occurs while walking or doing other activities, but it can also happen when you’re just standing. Many athletes, as well as others, suffer from chronic ankle instability. People with chronic ankle instability often complain of:
- A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
- Persistent (chronic) discomfort and swelling
- Pain or tenderness
What Causes It?
Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance.
Repeated ankle sprains often cause—and perpetuate—chronic ankle instability. Having an ankle that gives way increases your chances of spraining your ankle repeatedly. Each subsequent sprain leads to further weakening (or stretching) of the ligaments—resulting in greater instability and the likelihood of developing additional problems in the ankle.
Ankle Tendon Injuries
What are the Peroneal Tendons?
A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.
Types of Peroneal Tendon Injuries
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Following are the basic types of peroneal tendon injuries:
1. Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain).
Symptoms of tendonitis include:
- Pain
- Swelling
- Warmth to the touch
2. Acute tears are caused by repetitive activity or trauma.
Immediate symptoms of acute tears include:
- Pain
- Swelling
- Weakness or instability of the foot and ankle
3. As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher.
4. Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time—often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The signs and symptoms of degenerative tears may include:
- Sporadic pain (occurring from time to time) on the outside of the ankle
- Weakness or instability in the ankle
- An increase in the height of the arch
5. Subluxation occurs when one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:
- A snapping feeling of the tendon around the ankle bone
- Sporadic pain behind the outside ankle bone
- Ankle instability or weakness
Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a podiatrist immediately.
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