Hi, there's a lot of misconceptions out there about adult acquired flatfoot
or adults that have painful flat feet or tendons that have given out in a
condition called posterior tibial tendon dysfunction.
There's a lot of misconception out there also about what podiatrists do
and what orthopedic surgeons do.
Now, there are some excellent podiatrists
that do reconstructive surgery,
there are some excellent podiatrists that do foot surgery,
there's some excellent podiatrists who don't do any surgery.
So there's a lot differences and variation in training.
My specialty is reconstructive surgery of the rearfoot and ankle
but I also do general podiatry.
And the reason why I think we should address that is because I've seen and heard a
lot of patients come in to my office saying, "Hey, my other podiatrist said nobody
in this town or this area can handle my condition" or "no other podiatrist can
handle my condition, I have to go see a foot and ankle orthopedic surgeon."
and this is from my own colleagues,
whether it's from the lack of education of my older colleagues
as to what our new training protocol is for podiatrists is
or just plain-old competition wanting to refer patients away from the field
so they don't look inadequate.
This is something that's a problem in our field.
Now orthopedic surgeons there are... they come varying good and bad
as everybody has their good and bad
We have some excellent foot and ankle orthopedic surgeons and we have some not very good.
So it's about the individual.
So to classify a doctor just by their degree as far
when it comes to reconstructive ankle surgery is not so easy.
I will say the best way to assess that is the doctor's track record,
you know, have they been around for a while?
Have they done enough reconstructive surgery?
What are the results?
I am open to sharing my results
with the general public, hence my copious amounts of videos as you see on
Google+ as well as YouTube
I want to share with you the diversity of cases
that I do and the benefits we could provide for our patients that you might
not get elsewhere, where you could be misled.
So these are some couple of cases
about adult reconstructive flat foot procedures from my patient
that is 80 years old and another patient that is 46 year old
both happened for different reasons but at the end of the day severe ankle pain, flattening of the foot,
flattening of the arches and inability to walk
inability to wear braces, this one we undergo surgery
sometimes braces are sufficient that is the actual gold
standard for non-surgical care is putting patients in a custom brace.
We offer that also.
So listen to our patients, see what they have to say and
definitely looking forward to hearing from you
if you have adult acquired flatfoot
or posterior tibial tendon dysfunction
I also deal with pediatric and adult flatfoot,
we treat pediatrics differently.
This video illustrates that two patients with
adult acquired flatfoot, one in the 40s and one in their 80s, again both for
different reasons for the same ideology and same surgical procedure was chosen
with excellent results.
Thank you.
This is a patient with double arthrodesis,
this is the incision on the medial side but also there was a
posterior tibial tendon repair too
hence the incision going a little bit higher
we're gonna take a look at this side, she's about four months out of surgery right now
Do me a favor move that ankle up and around
in a circle, up and around
any limitation in your ankle range of motion?
No
How much pain do you have?
Very little.
How much pain did you have before surgery?
"Oh, excruciating"
You were begging for the surgery, you had a big lump and a bump here too
that we took down so
"Brought tears to my eyes"
Are you happy with the results so far?
"Oh, yes"
Any advice for people who are thinking about this surgery
thinking that we're gonna limit too much range of motion?
"Don't wait too long"
That is correct, look, that range of motion is perfect, that range of motion is
coming from the ankle not from the talonavicular or the subtalar joint. Now as
you can see, this is done via the one-sided approach versus a double
approach which is typically done.
The purpose behind the single approach versus double approach
is the single approach allows us to access both joints
through one incision, less healing time and less complications as well as better exposure
for the surgeon who is familiar with doing that double incision,
I mean, single incision versus double incision.
Double incision will entail the same incision on this side but also an incision on this side too
which you see there's no incision over here and the swelling is wonderful so we
took out one possibility of complication from this surgery by making only one
incision for this procedure.
The patient has been walking in cam boot with zero pain
at this moment, as you can see the swelling is awesome, she does not have any.
Let's take a look at the x-rays.
Well this is that same patient that we looked at before
for double arthrodesis,
she is 80 years old, this is four months out,
this is double arthrodesis, able to access this double arthrodesis
through one incision this is the
this is the fusion, notice the osseous healing.
This is the same exact patient
from the AP and oblique view. Notice the washer for the screw in order to obtain
the proper purchase of that screw
secondary to her being 80 years old and
having non proper weight bearing on the navicular,
talonavicular joint for some time
so we did have some difficulty in having proper screw
purchase but the washer of the arthrodesis in the site in position and
as you can see arthrodesis has progressed exceedingly well
with the talonavicular joint completely fused
calcaneocuboid joint is in proper alignment, this
is complete weight bearing views.
48 year old female with a history of tarsal
tunnel syndrome as well as collapse of the foot, it was a severe collapsed foot,
could not tolerate a AFO although you did wear AFO for about a couple years right?
"Right, two and a half."
Two and a half years. So here she is.
We did a tarsal tunnel release,
she was having nerve symptoms down the medial ankle. This again, this is the
incision for double arthrodesis
usually goes from here
to here, I had to extend it more proximally on
this end just so we can go ahead and release the tarsal tunnel as well as
repair the posterior tibial tendon.
Again, this is all the scar, there's no
scar on the lateral aspect. This is a single incision double arthrodesis.
We are at about four months post-op on this patient right here and she has no pain,
she's been walking around
no tingling or burning sensation
before surgery am I correct? Yeah.
Can you move the ankle up and down?
A lot of people are afraid of being stuck but you're really not stuck when
we do a double arthrodesis.
"I've been doing my own little bit of therapy
at home to help get through the day."
No, it looks good, your bone have been looking good.
Any tips for people who are anticipating surgery or scared of the surgery?
"They shouldn't really be as scared of the
surgery and they should talk to the doctor a little extra effort about it to
make sure they know everything before surgery so they don't get too scared."
Okay.
"And the doctor will work a little extra time to make sure if you have any
doubts or fears."
And obviously experience of the doctor doing the surgery too
"Right"
Makes a huge difference in the outcome.
"And sometimes the second opinion is
better than the first opinion."
Was I your second opinion?
"Yeah because the first
guy was worse." Well what did the first guy tell you?
"Dr. Goodman he said I just
had fasciitis pain, take a mild muscle relaxant and go to yoga."
Well, yoga would not help that.
"No, there was something more going on than that."
Your foot was
your ankle and foot was in a progressive collapse
"Yeah he just billed the insurance company he didn't really want to deal with it
so I got a better doctor."
Well we can't help with that but if we did fix your problem
very happy we've done well.
I'm gonna get you an ankle brace today and get you out of that boot today
how's that sound?
"Alright that's good, yes"
"I'm healing about three weeks
sooner than I expected." I think you are,
you've actually surprised me
you've done very well
"Yeah I did everything you told me to do right down to the T."
Great, well you've been an excellent
patient my friend.
I'll show your x-rays and --"A little impatient at times with the cast, but I was fine."
Overall the outcome was great. "Yeah."
This is the same patient
this is a double arthrodesis
again this is a single screw the talonavicular joint
also there was a posterior tibial tendon repair
there was os tibiale externa on the side, extra piece of bone.
This is two screws again
fixating the subtalar joint as you can see she has progressed faster than I
expected and she has some good fusion right across those sites.
This is the same patient this is double arthrodesis
again this is single screw the talonavicular joint
also there was a posterir tibial tendon repair
there was an os tibiale externum on the side
extra piece the bone this is a two
screws again fixating the subtalar joint as you can see she has progressed faster
than I expected and she has some good fusion right across those sites.