Cryosurgery for Morton’s neuroma…is it a better way?

The bottom line is that we still have a lot to learn about Morton’s neuroma.  For instance, in medical circles, we still don’t have a clear understanding of why Moron’s neuroma occurs in the first place.  Sure, we can agree that Morton’s neuroma occurs as the result of compression from the adjacent met heads.  And we can agree that the common intermetatarsal nerve is entrapped and held in place for a number of anatomical anomalies.  But what makes one person pron to this condition while others never experience it?  And it stands to reason that if we still don’t have a clear understanding of why Morton’s neuroma occurs in some folks, then how do we make good, logical surgical choices.  That’s why so many patients who experience symptoms of Morton’s neuroma look for answers outside of their doctor’s office.

Cryosurgery is one option.  But is it better?

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Could my foot pain be due to an old back injury?

A common and often over looked contributing factor to foot pain can be an old injury of the lumbar spine.  Radiculopathy is the term used to describe compression of the peripheral nerves as the exit the lumbar spine.  Compression of the nerve root can result in localized pain, but also it may produce radiating pain.  The most common location for this problem is L4-5 that results in pain down the lateral aspect of the lower leg an onto the top of the foot.  For more information, click comments.

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Hammer toes – can they be corrected with surgery?

Hammer toes can be corrected but there’s a number of subtleties that you need to know going into the surgery.  Most doctors categorize hammer toes as flexible or rigid (Kelikian push-up test).  By definition, flexible and rigid hammer toes have different types of surgical procedures.  What’s the right choice?  Click on comments for additional discussion about hammer toes and their correction.

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Brostrom lateral ankle stabilization – what’s normal post-op protocol?

Brostroms have become very popular as of late due to the ease of completion in comparison to procedures that require transfer of the peroneus brevis.  The Brostrom is a very simple concept; use the body’s own tissue to create scar tissue and in effect, re-create the lateral ankle ligament(s) with scar tissue.  Inherent in that concept is a period of time where the ankle is casted.  The intent of the cast is to purposely promote the formation of scar tissue as the ankle heals. 

So to enable this scar formation, a period of immobilization is important.  But when is it appropriate to become ambulatory again?  What’s the normal post-op course?

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In-toed gait…what are the treatment options

Parents will often contact my office regarding in-toed gait or what used to be called pigeon toed gait.  They’ve contacted their pediatrician who didn’t seem concerned about the problem and said something to the effect of ‘don’t worry, junior will grow out of that.’

But is that true?  Will kids out grow a problem with in-toed gait?  Maybe.  but as in any medical problem, the first thing to establish is a good diagnosis through a history and physical exam.  Once the location of the problem is defined, appropriate treatment can be initiated.  What treatment?  That will depend upon the child’s age.

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Talar fractures

MVA’s seem to top the list of contributing causes for talar fractures.  Falls from a height come in a close second.  So what makes these fractures so unique?  First is the unusual nature of the talus; hard on the outside and soft in the middle.  And most importantly, the talus is 3/5 covered with cartilage.  The significance of this is that where there is cartilage, there’s no blood vessels.  So the talus is at risk due to its’ limited inflow of blood. 

What’s it take to get a talar fracture to heal?  Well, that all depends…..

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Morton’s Neuroma

I’ve always found that Morton’s neuroma presents as a bit of a treatment dilemma.  What’s the best method of care?  Is there a single better way to treat Morton’s neuroma?  Without sounding vague, the answer is that it really depends.

Cortisone has been used for years as a means of decreasing the inflammation surrounding the nerve.  Absolute alcohol has also has a renewed use as a means of intentional destroying the nerve through a means called chemical neurolysis.  And surgeries…there’s a number of different techniques.

So what’s the best method of care? 

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Brostrom stabilization – post-op care?

Brostrom stabilizations have really risen to the top of what most doctors now use for lateral ankle stabilization procedures.  Granted, for competitive athletes, we’ll still use a Elmslie or Christman-Snook transfer, but for the majority of folks, Brostroms really do work well.

What’s the standard of care post-op for a Brostrom?  Each doctor will vary in his or her choices, but for most you can expect 6 weeks in a hard cast following surgery.  From that point forward, I typically use a removable ankle brace.  Sports are still limited for another 4 weeks (total 10 weeks post op).  Ice, elevation and compression used every day to accommodate swelling.

Many folks question the use of ice, if it can really penetrate the cast.  Here’s a discussion that might help to give an idea to prospective Brostrom patients.

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Post-op care following an Austin Bunionectomy. What’s normal?

For most folks, undergoing a surgical procedure is a new and unique experience.  Therefore, most patients don’t have a good feel for what to expect post-op in terms of return to activity and what to expect as normal.

I have a bit of a unique perspective on the Austin bunionectomy in that I perform the procedure, but I’ve also had an Austin performed on my left foot.  From the surgeon’s perspective, I usually tell my patients to recognize that 75% of healing will take place in the first 2-3 months post-op.  The remaining 25% may take up to a year following the surgery. 

From the patient’s perspective, I remember experiencing a little pinch now and again for about 4 months post-op.  But what I remember most was the sense of a limitation of range of motion of the joint.  But as I became more active, that limitation of range of motion subsided and became less noticeable.

So what’s normal healing?  It really does vary person to person.

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Lapidus Procedure – what are the indications?

A Lapidus Procedure is the fusion of the first metatarsal base and cuneiform.  Normally the Lapidus is used a a method of bunion correction in cases of an atavistic cuneiform or hypermobile cuneiform.  but are there other indications for a Lapidus?  One participant in our forum has commented that their doctor has recommended a Lapidus as a solution to transfer lesions sub 2/3 metatarsal heads.  Granted, I’m just one man with one opinion, but it seems like a bit of a stretch to fuse the medial column in an effort to resolve a sub 2/3 lesion.

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