Foot and Ankle Center Blog

Posts for: February, 2015

Unlike most Americans who cannot wait to come home at night and kick off their shoes, some people with Metatarsalgia actually experience more pain when they walk in their socks or barefeet. Metatarsalgia is condition characterized by a sharp aching or burning pain and inflammation in the ball of the foot. It affects the metatarsal heads, the bones that make up the ball of the foot. The first metatarsal head behind the big toe is the most common area affected but it can also affect the other toes, the entire foot, or both feet. Other symptoms include tingling or numbness in the toes, pain around the second, third and fourth toes or only near the big toe, increased pain when you walk, run or jump, or when you stand or flex your feet. Patients with this condition often feel like they have a stone in their shoe or that their socks are wadded up causing them to walk on the side of their foot to avoid pressure.

Metatarsalgia can affect males and females of all ages. It is primarily related to repetitive stress and impacts on the foot, and often experienced by people who participate in intense physical activities or training such as running, tennis, soccer and basketball. Metatarsalgia generally occurs from a single cause but other factors that may contribute to this condition. These include wearing ill-fitted shoes (high heels), having certain foot and toe shapes (high arches, a second toe that is longer than the first metatarsal), being overweight, or older age. It can also be attributed to a stress fracture or other foot deformities like a hammer toe or bunion, or from Morton’s Neuroma (a fibrous tissue around a nerve between two metatarsal heads), diabetes, Rheumatoid Arthritis, fluid in the foot and gout.
There are a variety of home remedies that should be tried prior to contacting your physician or podiatrist. Some of the things that can be done include wearing proper fitting shoes indoors and outdoors, avoiding pressure and impact loads, resting your feet and keeping them elevated, applying ice throughout the day, taking anti-inflammatory drugs (such as ibuprofen), using metatarsal pads or sock absorption pads or arch supports.
 
If your pain persists for a month or so, schedule an appointment with your podiatrist for a diagnosis and proper treatment. There are a variety of problems that can cause symptoms similar to Metatarsalgia. Most likely it will be necessary to do a gait analysis to identify the parts of the foot that are receiving pressure, image tests (X-ray or MRI) or ultrasound to confirm if there are fractures or if the problem is related to a metatarsal drop or improper length. Imaging will also help your doctor determine if the pain is being caused by a Morton’s Neuroma. Blood tests may also be necessary to rule out gout, diabetes or arthritis.

New technological advancements in ankle implants and high patient satisfaction are the primary reasons total ankle replacement (arthroplasty) is on the rise. According to the American College of Foot and Ankle Surgeons, ankle replacements have doubled in the past year. Many medical practitioners believe that there will be fewer fusions and more ankle replacements in the future. This is particularly great news for people who are looking for an alternative to ankle fusion (arthrodesis) that takes away the pain but leaves the ankle immobile. Ankle fusion has been the gold standard procedure for end-stage ankle arthritis for some time and continues to be a very viable option; however, ankle replacement is becoming the treatment of choice, especially for baby boomers who want to continue their active lifestyles. Here are some of the more common questions and responses about ankle replacement.

Who are the Best Candidates for Ankle Replacement?
The best candidates for ankle replacement are typically suffering from osteoarthritis (degenerative arthritis) due to the wear and tear of the gliding surface over the end of the bones, or post-traumatic arthritis resulting from an injury that damages the cartilage. The best candidates are older than 50, healthy, less active, and less likely to subject the prosthesis to excessive demands from recreation or work activities.

What are the Contraindications?
Not all patients are good candidates for ankle replacement. Replacement may be contraindicated for people who are overweight or obese, or if a person has a severe ankle deformity that affects alignment or stability. People diagnosed with a peripheral vascular disease, neuropathy, or osteoporosis are not good candidates. Replacements are also not advised for younger candidates with active lifestyles, and people with physically demanding occupations.

How is Ankle Replacement Performed?
The surgical procedures vary depending on the type of prosthesis used. Basically, ankle replacement involves the removal of a damaged joint, reshaping the tibia (shin bone), fibula (lower leg bone), and talus (foot bone), and readapting the area for the attachment of the artificial joint (prosthesis). This is performed with precise instruments to create a level surface for the implanted prosthesis. The metal and plastic implants are then placed into the bone ends to function as a new ankle. Surgery is done while the patient is under anesthesia or spinal anesthesia. Surgery usually takes two hours to perform.

What is the Length of Recovery?
Patients spend the night in the hospital and are discharged the next day. Patients must use a walker or crutches for several weeks to relieve the ankle from pressure. It usually takes three months for complete recovery.

What are the Risks?
There are rare to slight risks of infection, damage to blood vessels, blood clots in legs and lungs, and fracture of the bones at the ankle joint. The most common complications are wound healing problems, nerve injury, component malposition, and persistent pain. Achieving proper alignment of the implants is difficult and cannot always be achieved. If results are not satisfactory, the joint may have to be removed requiring ankle fusion.

What Can You Expect After Ankle Replacement?
Treatment offers restored mobility, improved flexibility and function, and reduced pain. It will be easier to walk further without a walking aid. Patients are also able to retain the integrity and shape of their calf muscle and to participate in activities such as walking, biking, moderate exercises, golf, and swimming. Roughly 97 percent of replaced ankle joints are working very well after three years and 90 percent are working well after 10 years in the most recent peer reviewed literature. Quality of life is likely to substantially improve because of this treatment.
What Types of Ankle Replacement Devices are Available?
Consult with your physician and visit the supplier websites to learn more about the devices. Here are the most common ones that are FDA approved:

  • The Inbone Total Ankle (produced by Wright Technology and FDA approved in 2005) consists of a tibial and a talar component, and a high-strength polyethylene piece secured within a titanium holder.
  • The Salto Talaris Anatomic Ankle (produced by Tornier, Inc. and FDA approved in 2006) provides the anatomy and flexion/extension movements similar to a natural ankle joint.
  • The STAR (produced by Small Bone Innovations, Inc. and FDA approved in 2009) is the first three-component, mobile bearing ankle marketed in the US.

 

How Do I Get a Diagnosis and More Information?
As with all complicated foot and ankle disorders, consult with your orthopaedic or podiatric surgeon to determine if you are a good candidate for ankle replacement. Because of the complexity of the procedure, select a surgeon who has advanced residency/fellowship training in foot and ankle surgery, is board-certified in reconstructive rear foot/ankle surgery, certified by the medical supplier, and has a demonstrated track record of success.


Did you ever wonder what a day in the life of a foot and ankle surgeon is like? Every day, Dr. Sigle is “up and at ‘em” at six o’clock in the morning, and he’s ready for a long demanding day. He has a glass of juice, does a half-hour workout, kisses the kids and wife goodbye, grabs a coffee to go, and is off to the hospital for surgery or to the clinic he founded in 2011. Although his weekly schedule is fairly standard, there are times when something out of the ordinary happens and this month, something happened. Dr. Sigle had to pay a special visit to the legendary keyboardist from Journey, Jonathan Cain.

“I’ve known Dr. Sigle for a number of years,” said Jonathan. “He is a personal friend and my adviser when it comes to my foot care. He is so knowledgeable and genuine. I joke with him that he is becoming a rock star for foot care. He’s been interviewed on public radio and local talk shows, and is a spokesperson for the Podiatry Association. His articles on foot care are also reaching a lot of people. My feet take quite a bit of pounding when I am on tour, so every now and then I like to get his help to keep them in good shape. I can always count on his advice. Springfield has a real gem.”

Dr. Sigle’s credentials are impressive, but what is so noteworthy is that he has gone beyond the mainstream to refine his craft. During his three-year residency at Botsford General in Farmington Hills, Michigan, he participated in the Baja Project to provide surgical treatment for children with disabilities at the Mexicali Red Cross Hospital. Then he went on pediatric surgical missions to Tegucigalpa, Honduras, Central America, at the San Felipe Hospital. “This experience was extremely gratifying. Indigent peasants were brought into the hospitals with club foot deformities. Our surgery allowed them to walk for the first time and to live a normal life. It really fueled the fire inside me to become a surgeon and made me realize that I needed to get more surgical training,” said Dr. Sigle. He also did a Pediatric Orthopedic Surgery rotation at Children’s National Medical Center in Washington, D.C.

When given an opportunity do another year of residency at a prestigious program in San Francisco, Dr. Sigle jumped in with both feet. There, he received training in reconstructive rearfoot surgery, open fractures, foot/ankle fractures and dislocations, infection management, limb salvage, advanced wound care, and trauma.

“I was so very fortunate to study under Dr. Jack Schuberth at the San Francisco Bay Area Foot and Ankle Residency Program. He is one of the leading surgeons in the world, and he was my mentor. He was such an incredible inspiration. He had a profound influence in the way I practice, and I use his principals every day in the operating room and in the clinic. He taught me how to be surgeon and a doctor. He always stressed the importance of blending technical skills with humanitarian skills, how to listen and understand what a patient is feeling, and how to communicate. That has become the cornerstone for my relationship with patients,” said Dr. Sigle.

In 2004, Dr. Sigle finally returned home to Springfield to become a foot and ankle surgeon/podiatrist at the Orthopaedic Center of Illinois. He also became a member of the Physicians’ Panel at Memorial Medical Center’s Wound Healing Center. In 2007, Dr. Sigle received two separate board certifications from the American Board of Podiatric Surgery in foot surgery and in reconstructive/rearfoot and ankle surgery. Having both board certifications is a distinction that very few podiatrists attain.

After practicing for six years, Dr. Sigle traveled to Kurgan, Russia, for more advanced training.

“The training at the Gavriil Ilizarov Hospital was given by the surgeons who were trained under Dr. Ilizarov himself. Dr. Ilizarov was a pioneer bone surgeon known as the ‘Soviet Wizard of Bones.’ He developed procedures and medical apparatuses to lengthen, reshape, and connect deformed limb bones. In the past, patients with fractures that failed to heal or healed incorrectly had little treatment available to them. The only option for patients who required surgical removal of infected bone or cancerous bone was amputation of the affected limb. Ilizarov revolutionized these orthopaedic conditions, and his inventions are considered to be some of the greatest advancements in modern medicine. This training was a real eye opener for me, and it helped me expand my skills for complex foot and ankle reconstruction,” said Dr. Sigle.

Because of recent technological advancements being made in total ankle replacements and medical trends, Dr. Sigle also obtained training and certifications from Wright Medical in the INBONE Total Ankle Replacement, and STAR Ankle Replacement device.

According to Dr. Sigle, “Ankle fusion is the gold standard for end-stage arthritis, but new technological advancements in total ankle replacements and high success rates are causing people to opt for this procedure.”

Dr. Sigle founded the Foot & Ankle Center of Illinois in 2011 and became a clinical assistant professor for Southern Illinois University (SIU) HealthCare, Division of Orthopaedics.

According to Dr. Sigle, “Opening a center dedicated solely to foot and ankle care was been a personal goal since medical school. I wanted to offer the convenience of a one-stop-shop to my patients to fix their foot and ankle problems. We offer a full range of services specializing in deformity correction, trauma, ankle replacement, ankle fusion, reconstructive foot and ankle surgery, sports medicine, pediatric care, diabetic wound care, and general podiatry as well. The center uses state of the art equipment to enhance diagnosis, to provide specialized treatments, and to streamline service.”

Diagnostic equipment includes a barrier-free digital X-ray machine to provide instantaneous imaging, a diagnostic ultrasound machine for special imaging and diagnosis, and smart exam rooms for viewing X-rays, patient education, and medical documentation. Barrier-free exam chairs are provided for patients’ comfort and accessibility. A casting room is available to produce molds for custom orthotics.

The center is also the first podiatry clinic between Chicago and St. Louis to offer GenesisPlus Laser and Cutting Edge MLS Pain Therapy Laser treatments. Both lasers are FDA approved.

According to Dr. Sigle, “Toenail fungus is a huge problem for many people. Conventional topicals and pills are not too effective and many people have adverse side effects. The GenesisPlus laser is safe, quick, relatively painless, and 70-80 percent effective. The Cutting Edge MLS Pain laser is the perfect option for patients who are at the end of the road with conventional treatment options, and tired of having to resort to drug therapy for pain relief. This technology is the wave of the future and many NBA and NFL teams are using it. It is effective for reducing inflammation and speeding the healing process. We use it to treat sports injuries, sprains and strains, occupational injuries, repetitive motion injuries, post-surgical swelling, tendonitis, wounds and bruising, arthritis, and bursitis pain. We have provided over one thousand treatments with both lasers and we are getting wonderful results.”

It is obvious that customer service is of paramount importance to the Foot & Ankle Center of Illinois because they became the first sub-specialty clinic in Illinois to join the KIARA Clinical Integration Network for electronic medical records. The electronic information system is integrated with the entire HSHS provider network. This includes patient scheduling and medical records to streamline the exchange of information with referring physicians, providers, and patients. This system also provides a billing system to simplify coding and collections. An added feature automatically contacts patients to remind them of their appointments.

According to Dr. Sigle, “The check-in process is fast and easy. Patient attendance rates and satisfaction rates are outstanding too. The electronic system is very convenient for other referring physicians, and it simplifies information documentation and exchange.”

The Center also has a comprehensive website that provides online registration and forms and an education library with videos, links to articles, publications, and audio podcasts.

“I try to develop a collaborative relationship with every patient. A better informed patient is able to understand the problem, diagnosis, treatment options, and work with me to formulate a medical plan to heal, restore, and rejuvenate their life. I encourage all patients to visit the website. It’s a very helpful resource,” said Dr. Sigle.

As an added convenience to patients, there is a store that includes a line of diabetic shoes, walking boots, shoe inserts, anti-fungal topicals, shoe sanitizers, nail lacquers, footpads and spacers, and other medical supplies.

“Many of our patients are not in good shape when they see me and an added trip to a store to buy medical supplies or equipment is a hassle,” said Dr. Sigle. “We do our best to accommodate our patients and provide reasonably priced items on hand for their convenience. The bulk of our patients live in Springfield and nearby communities but we have some traveling from one hundred miles away. We recently expanded our laser services to the Greater Peoria Metro area, and we are also opening a full-service podiatry clinic at St. Mary’s Hospital in Decatur this month,” said Dr. Sigle.

“We are totally patient centered and motivated to provide world-class foot care in the community I grew up in and in the surrounding areas in central Illinois. I love every aspect of my work and get great satisfaction from helping people who are so extremely appreciative. Despite all the changes and uncertainties that are coming in health care, I am optimistic that the level of care will continue to improve. My pledge is to have a positive impact on patients, colleagues, and the broader community. Regardless of what happens, we are committed to constantly improve our level of care and to be recognized as a leader in foot and ankle care,” said Dr. Sigle.

Dr. Sigle is a member of the American College of Foot and Ankle Surgeons, American Podiatric Medical Association, and Illinois Podiatric Medical Association. He is board-certified with the American Board of Podiatric Surgery in Foot Surgery and has advanced certification from the American Board of Podiatric Surgery in Reconstructive Rearfoot and Ankle Surgery. Dr. Sigle can be seen at the Foot & Ankle Center of Illinois at 2921 Montvale Drive, Springfield, Illinois, and at St. Mary’s Hospital at 1900 E. Lake Shore Dr., Suite 210, Decatur, Illinois. To schedule an appointment, call 217-787-2700. Visit myfootandanklecenter.com for more information.


New technological advancements in ankle implants and high patient satisfaction are the primary reasons total ankle replacement (arthroplasty) is on the rise. According to the American College of Foot and Ankle Surgeons, ankle replacements have doubled in the past year. Many medical practitioners believe that there will be fewer fusions and more ankle replacements in the future. This is particularly great news for people who are looking for an alternative to ankle fusion (arthrodesis) that takes away the pain but leaves the ankle immobile. Ankle fusion has been the gold standard procedure for end-stage ankle arthritis for some time and continues to be a very viable option; however, ankle replacement is becoming the treatment of choice, especially for baby boomers who want to continue their active lifestyles. Here are some of the more common questions and responses about ankle replacement.

Who are the Best Candidates for Ankle Replacement?
The best candidates for ankle replacement are typically suffering from osteoarthritis (degenerative arthritis) due to the wear and tear of the gliding surface over the end of the bones, or post-traumatic arthritis resulting from an injury that damages the cartilage. The best candidates are older than 50, healthy, less active, and less likely to subject the prosthesis to excessive demands from recreation or work activities.

What are the Contraindications?
Not all patients are good candidates for ankle replacement. Replacement may be contraindicated for people who are overweight or obese, or if a person has a severe ankle deformity that affects alignment or stability. People diagnosed with a peripheral vascular disease, neuropathy, or osteoporosis are not good candidates. Replacements are also not advised for younger candidates with active lifestyles, and people with physically demanding occupations.

How is Ankle Replacement Performed?
The surgical procedures vary depending on the type of prosthesis used. Basically, ankle replacement involves the removal of a damaged joint, reshaping the tibia (shin bone), fibula (lower leg bone), and talus (foot bone), and readapting the area for the attachment of the artificial joint (prosthesis). This is performed with precise instruments to create a level surface for the implanted prosthesis. The metal and plastic implants are then placed into the bone ends to function as a new ankle. Surgery is done while the patient is under anesthesia or spinal anesthesia. Surgery usually takes two hours to perform.

What is the Length of Recovery?
Patients spend the night in the hospital and are discharged the next day. Patients must use a walker or crutches for several weeks to relieve the ankle from pressure. It usually takes three months for complete recovery.

What are the Risks?
There are rare to slight risks of infection, damage to blood vessels, blood clots in legs and lungs, and fracture of the bones at the ankle joint. The most common complications are wound healing problems, nerve injury, component malposition, and persistent pain. Achieving proper alignment of the implants is difficult and cannot always be achieved. If results are not satisfactory, the joint may have to be removed requiring ankle fusion.

What Can You Expect After Ankle Replacement?
Treatment offers restored mobility, improved flexibility and function, and reduced pain. It will be easier to walk further without a walking aid. Patients are also able to retain the integrity and shape of their calf muscle and to participate in activities such as walking, biking, moderate exercises, golf, and swimming. Roughly 97 percent of replaced ankle joints are working very well after three years and 90 percent are working well after 10 years in the most recent peer reviewed literature. Quality of life is likely to substantially improve because of this treatment.
What Types of Ankle Replacement Devices are Available?
Consult with your physician and visit the supplier websites to learn more about the devices. Here are the most common ones that are FDA approved:

  • The Inbone Total Ankle (produced by Wright Technology and FDA approved in 2005) consists of a tibial and a talar component, and a high-strength polyethylene piece secured within a titanium holder.
  • The Salto Talaris Anatomic Ankle (produced by Tornier, Inc. and FDA approved in 2006) provides the anatomy and flexion/extension movements similar to a natural ankle joint.
  • The STAR (produced by Small Bone Innovations, Inc. and FDA approved in 2009) is the first three-component, mobile bearing ankle marketed in the US.

 

How Do I Get a Diagnosis and More Information?
As with all complicated foot and ankle disorders, consult with your orthopaedic or podiatric surgeon to determine if you are a good candidate for ankle replacement. Because of the complexity of the procedure, select a surgeon who has advanced residency/fellowship training in foot and ankle surgery, is board-certified in reconstructive rear foot/ankle surgery, certified by the medical supplier, and has a demonstrated track record of success.

If you suffer from chronic, unexplained foot pain and you want a definitive diagnosis, call Dr. Sigle today at 217-787-2700 for an appointment. Dr. Sigle can be seen at the Foot & Ankle Center of Illinois in Springfield, Illinois, and at St. Mary’s Hospital in Decatur, Illinois. To learn more about arthritis and ankle replacement, visit www.myfootandanklecenter.com.

 


It is estimated that more than 7 million American suffer from ingrown toenails each year. This condition spans all ages from younger children to older seniors. Ingrown toenails occur when the corner or side of the nail grows into the skin instead of growing over it. Ingrown toenails most commonly occur in the big toe but other toes may be affected as well. There are different reasons why ingrown toenails develop. For younger people, the nail usually gets embedded into the skin because the nail is wider than the nail bed. Older adults who have curved, thick toenails are more susceptible to this problem. Often, this condition can be taken care of at home with proper nail cutting techniques, practicing good hygiene, and wearing proper fitting shoes. If the pain gets too severe and home remedies fail, it’s usually time to see a podiatrist.

Unfortunately, most of the patients I see with this condition are in excruciating pain because they waited too long to seek treatment or because they took it upon themselves to perform “bathroom surgery.” Some patients attempt to correct the problem by digging under the toenail with a sharp manicure scissors or razor blade. Some use a needle from the sewing box to drain the pus. Others use pliers to remove the nail. When asked why they waited so long to get treatment their typical response is, “I was scared to death to have my toenail removed!”

The most common cause is attributed to ingrown toenails is improper nail cutting (cutting nails too short or leaving a spicule of nail in the groove when rounding the corners). Other causes are from wearing shoes and socks that are too tight, and trauma to the toes. Of course, genetics are attributed to this condition (where the nail is too large for the toe or the shape of the nail is curved), as well as arthritis, diabetes, a change in body weight, a change in gait (usually attributed to an injury to the foot, leg or back), and toenail fungus (a thickening of the nail and fungal infection in the nail bed).

Although ingrown toenails are a minor problem for most people, this condition may become quite severe for diabetics and people with poor circulation resulting in gangrene of the toe. Patients with pace makers and joint replacements are also at risk of bacteria spreading through the blood stream that may result in the spread of infection. It is critical for people at risk to seek medical treatment at the earliest sign of an ingrown toenail. Ingrown toenails may also cause a local infection of the nail fold (paronychia), scarring and bacterial tissue infection (cellulitis). Chronic granulation tissue can even develop into a squamous cell carcinoma in rare occasions. A biopsy is often needed in chronic infections.

Home care remedies include such things as soaking your foot in warm water 3-4 times a day, keeping your foot dry, elevating your foot as much as possible, wearing loose fitting shoes and socks with adequate toe space, and using ibuprofen or acetaminophen for pain relief. After soaking, you may use a sterile cotton tip to gently roll back the piece of overgrown skin. You may also gently lift the edge of the nail and insert a piece of sterile cotton or waxed dental floss between the nail and skin to facilitate drainage and to prevent further nail penetration. If this is done, change the packing daily. If your condition worsens and you do not see an improvement within two–three days, see your podiatrist.

If the conservative treatment does not work, minor surgery may be required. This is fairly simple and successful, and it provides long term relief that is permanent. There are several procedures that may be used, and almost all of them are done in the clinic under local anesthetic. Probably the most common procedure is a partial matricectomy which involves the removal of the nail down the side of the nail that is causing the problem. In the worst-case scenario, a complete matricectomy has to be done to remove the entire nail. In certain instances, we will allow the nail to grow back. The only time it will not grow back is when something is done to destroy the growth cells from regenerating the nail. The common way to prevent growth is to apply an acid to the growth center or surgically debriding the growth area. This treatment provides permanent relief.

The reality is that the surgical procedures are fairly easy and the most uncomfortable part of the procedure is numbing the base of the toe with anesthesia. As soon as the toe begins to numb the remainder of the procedure is pain free. Most procedures are performed within five to 10 minutes. Patients are amazed at how good they feel and how easy the procedure was. I love treating ingrown toenails because I can send the patient home feeling a whole lot better.

The good news is that in the vast majority of cases, recurring ingrown toenails can be prevented by trimming your toenails properly, using good hygiene, wearing comfortable shoes and socks, and avoiding trauma to your toes. If the condition recurs, use safe, conservative in-home remedies for a few days, and see your podiatrist if the problem worsens. You can avoid suffering and minimize down time if you follow these simple guidelines. Please do not perform bathroom surgery. Let the pros perform your ingrown toenail surgery. It’s usually a simple and quick procedure.

Contact Dr. John Sigle at (217) 787-2700 to schedule an appointment or visit myfootandanklecenter.com for more information.