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.