So you have an unstable ankle, but do you really need surgery?

You’ve had a number of sprains and your ankle is unstable.  But what is the hallmark sign that makes the decision for a lateral ankle stabilization?  When should you consider surgical stabilization?

Actually, there’s a number of different factors that come into play.  First, how active are you?  Are you young and semi-pro to pro in your sport?  Or are you mid forties and content with slowing down a bit?  How often do you sprain the ankle?  Does it feel unstable on flat surfaces?  Do you find yourself splinting the ankle at home while barefoot?

The choices for lateral ankle stabilization are getting better and better.  And in some cases, lateral ankle stabilizations can be performed arthroscopically.

<<comments and questions>>

Modified Kidner vs subtalar arthroeresis – what are the indications?

A modified Kidner procedure is often the procedure of choice when addressing a symptomatic accessory navicular.  But often patients will complain of posterior tibial tendon pain months to years after their Kidner procedure.  Why?  My belief is that the Kidner procedure may not be supportive enough for folks who are either (a) athletic  (b) over weight or (c) pronate to excess.

When assessing the patient with a symptomatic accessory navicular, you need to take into consideration the amount of rotational deformity (pronation or flatfoot) present.  If present, I believe that a simple Kidner may not be an adequate procedure to correct the problem.  The problem really lies in subtalar joint instability that needs to be addressed with subtalar arthroeresis.

Jeff Oster, DPM
Medical Director
Myfootshop.com

<<comments and questions>>

Topical antifungals for nail fungus – do they really work?

A question that I’m often asked is, “do topical antifungals really work?  Don’t I need an oral antifungal like Lamisil to clear my nails?”  For some folks, Lamisil can be a good solution.  But I’m inclined to think that most patients are going to fare better by using a topical antifungal on the nail.  My logic is simply based in cost and efficacy.  The cost of the oral medications is significant, not to mention the hepatic (liver) complications.  And efficacy?  the efficacy of both the oral and topical are the same.  But the big issue is compliance.  It’s easier to take a pill than it is to apply a topical medication.

More important though is the need for patients to understand that fungus is not a finite problem.  A fungal infection cannot be treated like a bacterial infection, ie ten days of penicillin kills the strep and it’s done.  Fungus will continue to come back.  So the key to treating the fungus is to have a plan…an ongoing plan.  And that’s why the tropicals may be a better long term solution.  If you just get in the habit of applying the topical on a daily basis, you’ll have a much better long term success in treating onychomycosis.

<<discussion and comments>>

Bone edema? What’s bone edema?

What is bone edema?  In most cases, this refers to swelling in the bone that occurs following an injury.  Swelling is not truly a fracture, but could be considered a finding similar to a fracture.  In fact, when bone edema occurs within a joint and under a layer of cartilage, we often refer to this as a stage 1 osteochondral fracture.  This fracture pattern was coined by Berndt and Hardy and often refers to the staging of fractures of the ankle.

<<comments and more information>>

Tailor’s Bunions

I just posted a new article in our foot and ankle conditions database on tailor’s bunions.  The article includes clinical images of tailor’s bunions and a number pre and post op x-rays of tailor’s bunion cases.  Also discussed are the symptoms of tailor’s bunions and treatment alternatives.

Jeff
Jeff Oster, DPM
Medical Director
Myfootshop.com

Myfootshop.com introduces a new line of pedicure and manicure instruments

We finally found a good supplier of reasonably priced manicure and pedicure instruments.  The new product line includes cuticle nippers, callus files, cuticle pushers and complete pedicure sets.

Enjoy…

Jeff
Jeff Oster, DPM
Medical Director
Myfootshop.com