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How To Solve The Dilemma Of The Jumbo Bunion

9733 reads | 8 comments

When it comes to surgical treatment of very large bunion deformities, I think we all scratch our heads a little and have to ponder what to do. For the average run-of-the-mill deformity, it is pretty much a slam dunk. You do whatever you are comfortable with such as an Austin bunionectomy, Scarf bunionectomy, distal-L osteotomy, etc.



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Secrets To Navigating Hammertoe Surgery On The Fifth Toe

10600 reads | 3 comments

This blog is dedicated to the ultimate podiatry oxymoron: a simple hammertoe surgery of the fifth toe.

When it comes to foot surgery, we all got our start working on toes. In school, we all learned the three etiologies of hammertoes: extensor substitution, flexor substitution and flexor stabilization. Based on those theories, we learned a surgical algorithm. Once we got into residency, we learned that nobody really used the "textbook" for making a decision on what to do surgically.



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Evolution Of A Jones Fracture

7092 reads | 5 comments

In an earlier blog (http://tinyurl.com/285eurj ), I discussed the common lateral foot and ankle pain syndromes in the foot. I recently stumbled on a great case, which is applicable to that theme.

Stress fractures are common in the foot and they most often affect the metatarsal bones. The distal second metatarsal neck is the most common site of a stress fracture in the foot. Stress fractures of the third or fourth metatarsals are less frequent. I think we can all agree that stress fractures of the first and fifth metatarsal bones are relatively rare.



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Key Considerations When Recommending Elective Foot Surgery

3425 reads | 3 comments

The decision to recommend foot and ankle surgery is not always straightforward. Unless the clinical condition is a serious fracture, abscess or dislocation, we have to rely on other criteria. Unfortunately, the criteria that we rely on are mostly anecdotal.

For example, we all learn somewhere in our training that we should consider surgery for plantar fasciitis after six months of active treatment, which usually includes a series of cortisone injections, physical therapy, orthotics and possibly an immobilization period. Do you always adhere to this treatment protocol dogma?



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When A Patient Pursues Surgery With Another Surgeon

2815 reads | 1 comments

I received a phone call from a colleague, who was upset because a patient whom he worked up for surgery went somewhere else to have the surgery done. He happened to be in the hospital where he saw his patient’s name on the surgery scheduling board having surgery with another surgeon.



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How A Solid Routine Can Help You Tackle Any Surgical Situation

2845 reads | 3 comments

Some people may call me boring. Some may think I am predictable. I call myself disciplined and regimented.

To illustrate, my closet is lined with identical pants and dress shirts so I wear the same clothes to work each day. If I have surgery, I wear surgical scrubs. If I am in the office all day, I wear khaki pants and a blue dress shirt. That way, I do not have to make any decisions in the morning as I know exactly what to wear.



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Why Metatarsalgia May Not Be What It Seems

41622 reads | 2 comments

I want to dedicate this blog to facilitate a better understanding of metatarsalgia. If you think of the top 10 problems that you see on a daily basis, “ball pain” is probably somewhere on that list. So when you walk into the treatment room with a new patient and your medical assistant says the patient is complaining of pain in the ball of the foot, what are you thinking? Maybe it is simply a dermatological problem such as a callus or wart. Maybe it is a Morton’s neuroma or a metatarsophalangeal joint (MPJ) problem such as capsulitis/bursitis.



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Why You Should Not Write Off The Opening Base Wedge Osteotomy

7510 reads | 2 comments

When it comes to bunion surgery, we all have our “favorite” technique. Not only do we have a comfort level with the technique, we feel we can use this technique or simple modifications thereof to fix most bunion deformities. In this blog, I want to remind you of an old procedure that has become revitalized recently.



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What To Do When A Difficult Patient Walks Through Your Door

3806 reads | 0 comments

In this blog, I want to share with you strategies to help you better understand and treat the patient that you may deem “difficult.”

So what do I mean by difficult? I am not referring to a difficult diagnosis but rather a difficult emotional status of the patient. One of my mentors, John Ruch, DPM, describes this patient as the “delicate flower.”



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Striving To Stay At The Top Of Your Surgical Game

2417 reads | 1 comments

I have been practicing for 12 years now and some things have not changed. I still worry about my patients. I often wake up in the middle of the night feeling flushed when the stress of a recent surgery or an upcoming surgery is on my mind.

You run the surgery over and over in your head questioning whether the fixation is strong enough. Will the patient be adherent? Did I get enough correction? Will the correction hold over time? Did I do the best procedure for that given circumstance?