New Advancements for Hammertoe Surgery
By John M. Sigle, DPM, FACFAS
If you are suffering from hammertoe pain and discomfort and hate the appearance of your feet, you are not alone. Jennifer, a 37-yearold mother of three children under the age of six, has endured painful hammertoes in her feet since she was a teenager. As a child, she began ballet at the age of six. Jennifer’s hammertoes started as mild deformities by the time she was ten. During her teens, she participated in modern dance and was on the cheerleading squad in college. These activities caused additional trauma to her toes. Jennifer’s hammertoes got progressively worse over time. After college she accepted a corporate position in sales that required her to wear high heels. Her pain and discomfort was obviously aggravated by her choice of shoes. By the end of the working day, Jennifer’s feet were swollen and she experienced a burning sensation in her toes. As Jennifer’s hammertoe deformity progressed, her toes became more ridged and permanently bent. Pain and discomfort became intolerable when playing tennis or jogging. Corns and calluses began to form as well as open sores. Eventually, she just skipped doing activities she loved because she couldn’t tolerate the bolts of sharp, aching pain. Jennifer’s hammertoes also became unsightly, causing her embarrassment. She had a difficult time wearing open-toed shoes and sandals during the summer. She was particularly embarrassed when she went barefoot at the pool with her children. Even getting a pedicure caused anxiety. Throughout her life, Jennifer tried most of the conservative treatments like over-the-counter pain medications, wearing larger shoes, using shoe inserts, toe cushions, toe protectors, toe separators, and toe loops. She even tried doing toe exercises and stretches. Jennifer did everything possible to avoid surgery, mostly because of the horror stories she heard where things went wrong. It is evident that the problems caused by hammertoes for many women go well beyond their wardrobe. Many women however, are at a crossroad and seriously ready to explore surgical options. Here are some of the common issues we talk about when patients come schedule a consult for hammertoe surgery. When is surgery an option? Surgery becomes a viable option if the conservative treatments do not improve your symptoms or alleviate the pain. If the deformity is the result of a nervous system problem or a condition that affects your blood vessels, surgery may not even be an option. What kinds of surgery are available? There is no single surgical procedure that is best for everyone because each patient is different. After conducting a thorough assessment of the underlying causes, your surgeon will know when surgery is the best option for you. Multiple surgical procedures are available, and each one accomplishes a slightly different outcome. Your surgeon may have to mix and match procedures to select the best surgical plan for you. Usually, surgery is done on an outpatient basis with a local anesthetic, and you are allowed to go home the same day. Most of the time you are permitted to walk after surgery and you are not put in a cast; however, this may not be the case if other more extensive procedures are required to correct your foot. Some of the types of surgeries include: • Resection — removal of bony prominence in a toe joint that prevents the toes from straightening. • Tendon transfer, lengthening, or release — re-routing the tendon to put it in a more balanced position, relaxing the tendon so the toe can be straightened, or restoring the alignment to ease the tension in the joint. • Metatarsal shortening — shortening the long bone to provide more space for the toe to extend into footwear. • Arthrodesis — removal of part of the joint, letting the toe bones grow together to minimize or eliminate motion and pain. • Arthroplasty — removal of a small portion of the joint to improve range of motion and flexibility. • Toe implants — toe implants are an alternative to traditional surgical treatments. This is a new procedure consisting of surgical corrections and toe straightening by inserting a small screw into the bone. The implant is permanent and preserves the correction. • Several of these procedures require the implantation of orthopedic products to fix the deformity and to neutralize the soft tissue imbalances that contribute to the deformity. Can multiple deformities be corrected at the same time? Often times, when patients with hammertoes have bunions or other foot deformities on the same foot, surgery can be done at the same time. When there are bilateral deformities (present of both feet) surgical options become more complex and may vary. Your foot and ankle surgeon will take into consideration the extent of the deformities, number of toes involved, age, and activity levels when developing a custom surgical plan that will accommodate your situation. How long is recovery? Recovery varies depending on the type of surgery performed. In minor instances that require a release or lengthening of the tendon, surgery is simple and quick, and recovery time is minimal. In moderate cases that use permanent implants that remain in the bone, recovery is fairly simple because there are no wires protruding from the ends of the toes. Healing occurs over a few weeks with full recovery within a month or two. Traditional hammertoe surgeries that use exposed K-wires that protrude beyond the end of the toe are left in place for four to six weeks and removed in clinic. It may take four to six months to fully recover. During recovery, these patients are required to stay off their feet. Openended shoes are worn to accommodate the wires that are beyond the end of the toes. For the more extensive surgery, patients who have a sedentary job can usually return to work as quickly as two weeks and within two months if their job requires standing or walking. What are the success rates for hammertoe surgery? The success rate for hammertoe surgery is estimated at approximately 85 to 90 percent; however, it is difficult to predict the results of hammertoe surgery because there is such a wide variety of deformities and surgical variables. The standard K-wire technology that has been widely used for the past 30 years continues to be the predominant method of choice. Many foot and ankle surgeons are beginning to use a wide range of toe implants because they are producing positive outcomes. This technology offers fewer complications, faster recovery, and less chance of infection. Corrected toes remain in place and are less likely to revert back to their hammertoe position. What are the risks? As with any surgical procedure, there are risks associated with hammertoe surgery that should be discussed with your surgeon. Also, your physical makeup (age, weight, and medical history) determine specific risks. Consult with your surgeon to understand the pros and cons of all non-surgical and surgical treatment options. Where can I get additional information? Don’t let hammertoes cramp your style! If you are interested in seeking a board-certified surgeon for information about hammertoe treatment or surgery, call Dr. John M. Sigle or Dr. Grant Gonzalez at 217-787-2700 for a consult. The Foot & Ankle Center of Illinois is conveniently located in Springfield, Decatur, Taylorville, Carlinville, Shelbyville, and Sullivan. Also visit myfootandanklecenter.com for more information on new advancements in hammertoe surgery.
Whether it's dropping a can of soup on your foot or whacking your toe against a wall, we've all been there before—hopping and holding our beaten, bruised toe. While you may not think anything of these common “stubs,” you may soon experience a throbbing, swollen, broken toe. A broken toe is painful, so don’t suffer through it—visit your podiatrist for a diagnosis and proper treatment plan.
How Is a Broken Toe Treated?
Treatments for a broken toe aim to reduce the pain and swelling and help the fracture heal properly. Your podiatrist offers these at home solutions:
- Elevation – by keeping your foot raised above the level of your heart, you can help decrease swelling and discomfort. Prop your foot up on some pillows, especially when sleeping.
- Ice – put ice in a plastic bag and apply it to your injured toe for 15-20 minutes every 1-2 hours. Do this for the first day or two. Don’t forget to place a towel between the skin and the ice to keep your skin protected.
- Rest – avoid any strenuous exercise, prolonged standing, or walking. You may need crutches or a special shoe to avoid placing extra weight on the broken toe.
Depending on the location and severity of your broken toe, your podiatrist might need to splint or cast your toe. Contact us for further diagnosis and treatment planning for the proper healing of your broken toe, so that you can get back to your normal day-to-day schedule.
By: The Foot and Ankle Center of Illinois
The Podiatry Institute is a nationally and internationally recognized non-profit educational foundation that offers a variety of programs conferences, workshops and postgraduate courses for advancing podiatric medicine and surgery.
The faculty members are all volunteers who are committed to ongoing education in the area of foot and ankle surgery.
Last month, Grant Gonzalez. D.P.M., from the Foot & Ankle Center of Illinois, Springfield, IL, taught a Forefoot Cadaver Surgical Course at the Podiatry Institute of DeKalb Medical Center in Decatur, Georgia, with Casey Burchill, D.P.M.
The three-and-a-half day course was aimed at increasing the attendees comfort with performing common podiatric forefoot and basic rearfoot surgical procedures through live surgical observation and hands-on participation. The course included lectures and detailed instruction in surgical procedures for the foot and principles of internal screw compression fixation.
Participants were orthopedic and podiatric surgeons from ten different states across the country.
“We went through the forefoot and explained the details of different cases, normally starting with a lecture followed by a demonstration of the procedure, and then each participant would perform the procedure on their own individual cadaver limb,” said Dr. Gonzalez.
This process was repeated for several deformities including bunions, hammertoes, great toe joint fusion, midfoot fusion, and tailor’s bunion correction.
Additional time was provided to allow for exploratory dissection, and practice of previous procedures.
Dr. Gonzalez has taken time to answer some questions and speak more about his work and the lifelong process of learning.
Why it is important to continue education?
Dr. Gonzalez: Medicine and surgery are constantly evolving and the “standard of care” can change from one decade to another. Some procedures that were commonplace in my grandfather’s days have been completely abandoned today, whereas others have simply been improved.
How are you involved with the Podiatry Institute?
Dr. Gonzalez: All members of the DeKalb Podiatric Surgical Residency program work with the Podiatry Institute during residency, and are trained in medical education and lecturing. After graduating, we become faculty members and are able to lecture at Podiatry Institute Seminars across the country, along with moderating cadaver courses at the Institute. Residents applying for the program certainly understand the additional benefit of graduating from DeKalb and it is quite competitive.
What does it mean for patients to have such highly trained foot and ankle surgeons here at the Foot and Ankle Center of Illinois?
Dr. Gonzalez:. A surgeon with a greater knowledge base and skillset can offer their patients the greatest variety of treatment options and choose a procedure or treatment plan that is most appropriate for each individual patient, instead of practicing as a technician who uses the same cookie cutter approach for everyone.
Why do you use cadaveric limb?
Dr. Gonzalez: Cadaver limbs create a very realistic training environment mimicking the operating room experience as much as possible. This creates familiarity with the procedure and can hone surgical skills more effectively than alternative methods. As residents at DeKalb, we were able to perform every new procedure on a cadaver before ever doing one in the operating room, which gives additional practice, identifies difficult parts of the procedure and allow optimal planning for the surgery on an actual living patient. We don’t experiment in the operating room; generally every procedure has been fine tuned in the cadaver lab beforehand.
What is your favorite part about performing surgery?
Dr. Gonzalez: Diminishing pain and improving patient function through reconstructive procedures, whether they be minor or major, is the part that still leaves me in awe during and after every case.
You are a fourth generation podiatrist. How has surgery changed throughout your family timeline?
Dr. Gonzalez: There has been a bigger focus on scar minimization and reducing perioperative pain and swelling control than in years’ past. If I would have told my grandfather (Dr. Frank Siebert, also a Podiatrist) 30 years ago that we would one day have a laser that could reduce perioperative pain and swelling and decrease recovery times, he would have had a good laugh. Keeping people as ambulatory as possible postoperatively has also been a huge focus as it leads to less debility afterwards and reduces the overall recovery time.
The Foot & Ankle Center of Illinois is located at 2921 Montvale Drive, Springfield, and has outreach clinics in Decatur, Taylorville, Carlinville, Shelbyville, and Sullivan, IL.
Click HERE to learn more about Dr. Gonzalez. Contact the center at 217-787-2700.
With more than 30 joints in your foot, joint pain may seem like it can come from anywhere and everywhere. Swelling, tenderness, stiffness, redness, bruising or increased warmth--these all can come along with the pain and can be caused by trauma, infection, arthritis, bursitis, gout or structural foot problems. With such an unpleasant litany of symptoms and causes, it's helpful to know a few simple tips to ease your pain before you visit your podiatrist for a full diagnosis.
Joint Pain Treatment
When you first notice any joint pain in your foot and ankle, your podiatrist may initially treat your pain with RICE, which stands for:
Your podiatrist will also recommend limiting walking and bearing weight on the painful foot. Steroidal anti-inflammatory drugs, such as ibuprofen, can also help to reduce local inflammation and pain. Custom orthotics may also be prescribed to support the foot, particularly if the issue lies in foot mechanics. If your pain is caused by a condition such as gout, lifestyle changes and alterations in your diet may also help reduce or even eliminate your pain.
If you're experiencing immobilizing joint pain in your feet or ankles, your podiatrist is best equipped to determine the cause and recommend the appropriate treatment. What may seem like joint pain could also be something else entirely, such as a stress fracture, or could be caused by an undiagnosed autoimmune disorder, such as Rheumatoid arthritis. Schedule an appointment today to ensure accurate treatment and a speedy recovery!
By John M. Sigle, DPM, FACFAS
Content origianlly featured in the October 2017 edition of Healthy Cells Magazine
As a licensed Nurse Practitioner in Acute Care, Susan has been working 12-hour-shifts in the ER for 25 years. The amount of time on her feet has resulted in a severe bunion.
“I had my bunion for quite a while and seemed to get by with conservative treatments like shoe inserts and custom orthotics,” Susan said.
As the bunion grew, so did her pain.
“I knew it was time to find a surgeon and chose Dr. Sigle because I knew he was an advanced foot and ankle surgeon. During my initial consult we talked about the options. He told me that I was a candidate for a new surgical technique that would speed up my recovery and there would be minimal scarring,” Susan said.
“I didn’t have to use crutches or a cane. I walked out of surgery in a surgical walking shoe and was back to work within two weeks,” Susan said.
The pain, she said, was minimal, but did slightly increase as the work day progressed. She modified her demanding work hours from 12 to 8-hour shifts at first, but within a couple of weeks she had worked her way back up to the 12-hour average.
“I was pain free within a couple of months and able to resume my normal activities like walking on a treadmill and doing jumping exercises. I am totally happy that I did this. My foot looks beautiful and the scarring is on the side of my foot so it’s not really visible. I can’t even tell that I had surgery! Now I am thinking about doing the bunion on my other foot!” Susan said.
Susan is just one of the many patients electing to have Dr. Sigle perform this new bunion surgery.
There are probably over a hundred bunion surgery techniques. They are pretty straight forward: to relieve pain, to remove the bunion and keep it from returning, and to correct the alignment and mechanics of the foot. If done correctly, the appearance of the foot will most likely improve. Unfortunately, traditional practices often result in substantial pain, a long recovery time, and visible scarring. Many people are reluctant to have surgery and modify their normal routines and lifestyles to avoid surgery.
The more traditional surgical methods usually consist of an incision on the top of the big toe joint that extends toward the mid foot. Some techniques include an additional incision between the first and second toe on top of the foot extending to the mid foot. Wires, screws, pins and plates are typically used to stabilize the bones during healing. In the majority of cases, casting or boot immobilization is required along with non-load bearing crutches for 6-8 weeks. Consequently, patients are inactive and not able to return to work during that time at full capacity.
Here is the good news: Other more advanced surgical techniques that are minimally invasive are being used more often than traditional techniques. They are more effective at correcting the bunion condition, minimizing pain, enhance healing and recovery, and minimize scarring. Now, advanced foot and ankle surgeons are combining surgical techniques to achieve both functional and aesthetic results with a high degree of success.
A cosmetic approach with a smaller medial incision is made on the side of the foot that is hidden from the eye. It looks as though there’s never been any surgical work done, even while wearing sandals or being barefoot. Sutures are located under the skin to eliminate scarring and detection. Sutures are dissolvable.
Precise surgical bone cuts are engineered to withstand weight bearing, to realign toes, and to maintain proper foot structure and balance. Using the Swiss Compression Technique, tiny screws are used to fixate surgical bone cuts and to stabilize the realignment. Patients are not required to be put in a cast or on crutches. The Swiss Compression Technique allows patients to become weight bearing immediately after surgery in a surgical shoe. Patients can typically drive the day after surgery.
Most bunion surgery is done under light sedation and a local anesthesia so there is no tube and no hangover from the anesthesia. Surgery is done as an outpatient basis and patients go home the same day. Patients can drive the day after surgery, even if surgery was done to their right foot.
Minimally invasive procedures also minimize edema and pain. There is less internal scarring and damage to the tissue allowing for faster recovery time. Patients are not required to be put in a cast and or on crutches. They can begin walking immediately and, in most cases, wear comfortable athletic shoes within two weeks. Most women are back in their high heels in 12 weeks.
Patients are able to return to work faster and to their normal activities within a much shorter time than traditional bunion surgeries. Now patients can have their surgery done on a Thursday or Friday and return to work within 4-5 days. Although they are not able to make lengthy and demanding walks, they are able to get in and out of a car and walk to their office. They are extremely happy with the way their feet look and feel.
Patients of the Foot and Ankle Center of Illinois are also given an option to undergo MLS Laser Therapy to reduce edema and pain after surgery. Patients who elect to do this generally have faster recovery times.
If you are considering bunion surgery, select the right foot and ankle surgeon who is knowledgeable and experienced to customize a surgical plan that will result in the best outcome for you. Choose a surgeon with experience and one you can trust.
The Foot & Ankle Center of Illinois is located at 2921 Montvale Drive, Springfield, and has outreach clinics in Decatur, Taylorville, Carlinville, Shelbyville, and Sullivan, IL.
Visit www.myfootandanklecenter.com to view literature on the treatment of bunions or to view a short video clip on the new MLS Laser Therapy that is available following surgery. Contact the center at 217-787-2700.
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