RECONSTRUCTIVE FOOT & ANKLE SURGERY
Because your feet are at the base of your body, they bear the pressure of your weight. The stress of weight-bearing, combined with poorly fitting shoes, heredity, aging or disease, may cause or add to the development of painful foot problems. The goals of foot surgery are to relieve pain, restore function, and improve the way your foot looks and feels.

Considering Surgery
Once a diagnosis is made, Dr. Arminio will discuss your surgical options with you. Because foot surgery is usually an elective procedure, make sure it's right for you. Talk to Dr. Arminio about how the procedure will be performed and what you can expect during recovery.

• Although surgery may be done at Dr. Arminio's office, it's usually performed at a surgical center or hospital. You may be able to go home a few hours after surgery, depending on your foot/ankle problem.

• Plan Ahead: Arrange for someone to drive you home afterward. For your recovery, you may also want to arrange for a few days off work. You may have to wear a special shoe or use a cane or crutches for several weeks after surgery.

• Pre-Op Instructions: You may be advised to stop smoking and taking aspirin the week before surgery to prevent complications. Don't eat or drink anything (including water) after midnight the night before surgery, and bring crutches or a cane if recommended.

• Possible risks and complications of foot surgery include bleeding, swelling, pain, infection, and nerve damage (tingling or numbness). Before surgery, Dr. Arminio will discuss the risks and complications of your procedure with you and will answer any other questions you may have.

• Your doctor will discuss the type of anesthetic to numb your foot (local) or the lower half of your body (spinal or regional). In some cases, anesthesia helps you "sleep" through surgery.

EXTRACORPOREAL SHOCK WAVE THERAPY

New Options for Heel Pain Sufferers: Studies demonstrate that 15-20% of new patients seeking care by by foot and ankle specialists present with the complaint of heel pain. Plantar fasciitis, heel spur syndrome, heel bursitis, nerve entrapment, stress fracture, gout, and systemic inflammatory conditionsare just some of the possible causes. The vast majority (70-90%) of individuals diagnosed with heel spur syndrome/plantar fasciitis, respond to non-operative treatment. Until recently the only remaining treatment option for those individuals that failed to improve was surgical intervention. EWST (extracorporeal shock wave therapy) now offers heel pain sufferers new treatment choices. 

What is EWST?

Extracorporeal shock wave therapy is a new non-invasive alternantive to surgery. Similar technology has been used to successfully treat kidney stones since the 1980's. In this new application, the ultrasound device applies sound waves to the foot, aimed at the inflamed plantar fascia. While the heel spur is not removed, it is believed that "microtrauma to the tissue results in an effect similar to tenderizing meat" which causes the release of enzymes that reduce pain. The tissue irritation that occurs results in the ingrowth of new blood vessels to repair and heal the chronically irrritated fascia.

Who Qualifies?

Generally, an individual who has failed to improve after six months of conservative management would be considered a suitable candidate. This includes stretching, shoe inserts/orthotic devices, cortisone injections, non-steroidal anti-inflammatory drugs, physical therapy, night splints, CAM walkers, weight loss, and rest.  

Expected Results

A study by Weil, Roukis and Weil et. al., in The Journal of Foot and Ankle Surgery (Volume 41, No. 2) found that at an average of 8.4 months following treatment, 82% of thye patients treated with EWST were very satisfied or satisfied. This compares with 83% of patients that had undergone surgical release of the fascia.

What About Risks?

Adverse effects that have been reported from treatment seen to parallel the risks associated with the infiltration of local anasthetics, such as nerve injury or irritation, hematoma, bruising, and skin rash.

Post Treatment Care 

Patients that have undergone EWST may return to their pre-treatment level of function immediately following the procedure. That is, providing they are wearing supportive footgear, preferably in combination with orthotic devices/shoe inserts. Application of ice and the use of anti-inflammatory medication for the first several days may prove helpful. One may expect an increase level of discomfort three to seven days post treatment as the local infalmmatory response ensues. Athletic and strenuous weight bearing activities should be avoided for at least the initial two to three weeks.

Long Term Effects

Sufferers of heel pain must consider their symtoms as a condition which should be managed by continued compliance with stretching, supportive footgear and avoidance of barefoot activities as well as positions which place excessive load on the forefoot (i.e., standing on ladders, squating, walking uphill, etc.).

Fees/Insurance

Since EWST is a new application for heel pain, some insurance companies have not yet developed payment guidelines. Others have fees schedules which include coverage. Our staff will assist you with determining your share of the financial obligation. 

FRACTURES/SPRAINS

• Ankle Sprains: An ankle sprain occurs when ligaments in the ankle joint are stretched or torn. Most ankle sprains occur when the foot is suddenly turned inward, tearing the outside ligaments. Sprains of the ligaments on the inside of the ankle are less common because it is likely for the foot to be forced outward, and because inside ligaments are stronger.

• Ankle Fractures: A fracture occurs when one or more bones are broken and is usually caused by a sudden, forceful twist or hard blow to the ankle. Fractures may also be accompanied by torn ligaments. As with sprains, ankle elevation above the heart is very important. Ankle fractures are usually painful and may be accompanied by swelling and bruising.

• Ligaments are like strong cloth: tough, but when pulled to their limit, they can tear. Depending on the severity of the ligament tearing, a sprain can be either mild, moderate, or severe. The accumulation of fluids after a ligament injury gives rise to the characteristic symptoms of the sprained ankle: pain, swelling, and bruising.

• In a non-displaced fracture one or more bones are broken, but they remain in their normal position.

• Displaced fractures threaten the stability of the joint and require repositioning of the bone called "reduction." In a displaced fracture, your bones, in addition to being broken, are also thrown out of alignment.

Achilles Tendon Problems
The Achilles tendon is the prominent tendon at the back of the heel that is essential to walking, running, and standing. It is the strongest tendon in the body, but it can be injured by overuse or sudden exertion. Overuse can sometimes cause painful swelling (Achilles tendonitis), or with a sudden, forceful strain the tendon can snap (Achilles rupture).

• Overuse of the Achilles tendon can cause tendonitis (inflammation of the tendon). Achilles tendonitis often occurs when under-conditioned, weekend athletes push themselves too far, too soon. Rest is the best care, although in some cases, your doctor may determine that a cast, heel lift, or medication is necessary.

• Occasionally, the Achilles tendon can tear (rupture). The pain and disability make continued movement impossible. Surgical repair and casting may be necessary.

Sinus Tarsi Syndrome
Sinus tarsi syndrome occurs when a sprain doesn't heal properly and abnormal scar tissue forms. The scar tissue presses against small nerves, which run through the small space (sinus) where your leg and foot meet. You may feel pain when you move or touch the area near the sinus tarsi.

ORTHOTICS
Why you may need orthotic support:
If your heel swings too far when you walk, your foot may be overpronating, or flattening too much. This incorrect movement stresses and weakens parts of your foot. Over time, you may develop symptoms in your feet, ranging from a change in shape to pain when you walk. If a medical problem places your feet at risk, you may need help protecting their tender areas.

Orthoses Can Help
With years of medical training in foot care, your podiatrist is an expert in treating foot problems using orthoses. Just as contact lenses improve vision, orthoses improve foot movement. These custom-made shoe inserts may relive your symptoms by controlling the way your feet move. Orthoses may also help compensate for a problem in your hip or knee that causes incorrect foot movement. And orthoses may protect the tender areas of your foot from the wear and tear of constant use. Even if your foot problem is best-treated by surgery, orthoses may delay the need for surgery and help maintain your surgical corrections afterward.

An orthosis for every need
Orthoses come in a variety of materials, ranging from rigid plastic to soft foam. All of these materials can be shaped to fit your individual foot. Rigid materials offer the most control of movement, while softer ones feature better cushioning and protection. When prescribing your orthoses, we will find the best match between your needs and the qualities of the materials.

Customized support
Unlike store-bought shoe inserts, prescription orthoses are custom-made just for your feet. Generally, patients have orthoses for the shoes they wear most often, but they can be made for dress shoes, athletic shoes - even ski boots.

• A cast is first made of your foot so your orthoses can be built to your exact details.

• After casting both feet, the set is sent to a lab.

• An exact model of both your feet are made and a trained technician then crafts your orthoses to meet your prescription.

• This process usually takes about 4 - 6 weeks.

Realistic expectations
If you wear your orthoses as instructed, your symptoms can lessen over time. Also remember your orthoses can help you move more comfortably, but won't change the structure of your adult feet.

Follow-up visits
Once you're wearing your orthoses full-time, regular podiatric checkups can help you maintain the health of your feet. As with contact lenses, your orthotic prescription may change over time and your podiatrist may recommend new orthoses.

DIABETES
Diabetes can affect nerves in your feet and keep you from feeling injuries. Diabetes can also cause reduced or altered blood flow. This may prevent injuries from healing. Self-care includes keeping a close watch on your extremities. A "yes" answer to any of these questions may mean your feet are in trouble and need medical attention:

Do you ever have a slow-healing sore on your foot?
Yes  (  )    No  (  )

Do you feel tingling, numbness, burning, or lack of feeling in your foot?
Yes (  )   No  (  )

Do you have blisters, corns, or calluses?
Yes  (  )    No  (  )

Are your feet cold?
Yes  (  )    No  (  )

Are your toenails thick or ingrown?
Yes  (  )    No  (  )

When you have diabetes, daily wear and tear take their toll on your feet - especially where they absorb the most pressure. Because of poor blood flow or loss of feeling, even a tiny break in your skin may become infected and be difficult to heal.

• Blisters or calluses start as red or warm spots. They are often caused by unrelieved skin pressure.

• Ulcers (open sores) may result if blisters or calluses reach all the way through the skin. Ulcers may become infected.

• Bone infection may occur if infected ulcers spread. Untreated bone infections may lead to loss of the foot.

The first step in your foot health program is a thorough evaluation. Your podiatrist reviews your diabetes history, your overall health, and the condition of your feet. X-rays or other tests may also be done. The evaluation may show if your feet are unhealthy, even if you can't feel or see a problem.

Foot Examination
A foot exam can reveal circulation, nerve, skin, bone, or joint problems. Your podiatrist takes each foot's pulse to check how well blood flows.

Any minor foot problem - from a corn or callus to a crack in your skin - can became infected. If left untreated, infections can become life-threatening. Prompt treatment by your podiatrist can help clear up the infection and restore your health.

X-Rays are taken to check for fractures and the conditioning of the ankle mortise. X-Rays of the uninjured ankle are sometimes taken.

Self-Care: Inspecting Your Feet
Inspecting your feet helps you find small skin irritation before they become serious infections. Check daily for the warning signs listed below. They could mean your feet are in trouble. If you can't see your feet, ask a friend or relative to help. See your podiatrist right away if you find a problem.

• Color Changes: Redness with streaks is often a sign of infection. Pale or blue tones may mean blood-flow problems.

• Swelling, sometimes with color changes, may be a sign of poor blood flow or infection. Your foot may also feel tender.

• Temperature Changes: Warm areas may mean that your foot is infected. A foot that is cold or that has an abnormal change of shape may not be getting enough blood.

• Odd sensations like "pins and needles," numbness, tingling, burning, or lack of feeling may mean nerves are damaged.

• Red "hot spots" are caused by friction or pressure. Hot spots can turn into blisters, corns (thick skin on toes), or calluses (thick skin on the bottom of the foot).

• Cracks and sores are caused by dry or irritated skin. They're a sign that skin is breaking down, which can lead to ulcers.

• Toenails may grow into the skin, swell, or cause redness or pain. Thick or discolored nails may signal a fungal infection. Toenail problems should be treated by a podiatrist.

• Drainage and odor may result from untreated ulcers. White, yellow, or clear drainage, bleeding and odor are often signs of infections or dead tissue.

Call your podiatrist immediately if you notice:

• an open sore that isn't healing

• redness or streaking

• increased heat

• fever and chills

• swelling

PLANTAR FASCIITIS
Plantar Fasciitis is a common cause of heel pain. This chronic problem is an inflammation of the plantar fascia, a ligament-like structure that passes from the heel to the forefoot. The inflammation is caused by the fascia partially tearing or pulling away from the heel. A bony spur may also develop where the fascia and heel meet.

Doctor's care may involve anti-inflammatory medications, custom-made orthotic supports or heel cups, night splints, physical therapy, and, if necessary, cortisone injections. Complete recovery may take months.

Surgery can be performed to release the fascia in severe cases. It can be done traditionally (open surgery) or endoscopically (using a telescope-like instrument and small incisions).

A new, non-invasive  treatment is available utilizing shock-wave therapy.

BUNIONS
A bunion is an unsightly bump at the base of the big toe. Because bunions don't fit most shoes, the skin in the area can become irritated and swollen. Bunions, hammer toes, and metatarsalgia often appear together. Although bunions tend to be hereditary, wearing shoes with too narrow a forefoot or too high a heel can bring bunions on years sooner. Sometimes bunions develop with arthritis.

• Bunionette is like a bunion, but occurs at the base of the little toe. Treatment may include wearing shoes with a wide forefoot. Surgery involves removal of the bony prominence and realignment of the bone.

• Degenerative Joint Disease: With degenerative joint disease (arthritis or hallux rigidus), your toe is stiff and painful. The cartilage in your joints wears out, causing bones to rub together and create bone spurs. Surgery is performed in severe cases. Dr. Arminio may remove the spurs, fuse the rubbing bones, join them with staples, screws or pins, or replace the joint.

Connecting the bones
Bones in the hind foot may be fused so they don't rub together. Staples or screws may be used to connect the bones while they heal (later removed), and sutures and a dressing are applied. A cast may be used to immobilize the foot. Healing may take 3 months or more.

Shifting soft tissue
To realign the joint, soft tissue is released, the bunion is trimmed, and the metatarsal may be cut and repositioned. If so, a screw or pin is inserted into the first metatarsal to stabilize the bone. Then sutures and a dressing are applied. Healing may take 3 months or more.

Shifting the bone
Another common treatment for a bunion is to remove the bunion, cut and shift the metatarsal, trim off the excess bone there, and tighten up the soft tissue. A pin or screw may be inserted to stabilize the bones before sutures are applied. Healing may take 3 months or more.

Removing the bone spurs
A common way to treat degenerative joint disease is to trim off the bone spurs that prevent the toe from moving smoothly. Dr. Arminio will apply sutures and a dressing on the forefoot. Healing may take 6 weeks or longer.

INGROWN NAILS
An ingrown nail, can be caused by trauma, injury, or improper trimming of the nail. The nail grows into the skin, causing pain, swelling, and oftentimes, infection. If trimming the nail straight across hasn't helped the problem, the nail can be surgically repaired in the office. Surgical treatment for ingrown nails involves removing the portion of the nail that is growing into the skin. After the surgery is complete, a dressing is then applied, and the following day removed. Your toe may be healed in two weeks or longer.

FOOT ODOR
To prevent foot odor you must first eliminate the cause of the problem: Bacteria. A special powder works by killing the bacteria on your feet and in your footwear.

How do you use it?
Wash your feet as usual and towel dry. Sprinkle one capful of this special powder over each foot and massage into your entire foot. Repeat daily for 3 days. Wash hands after each treatment. To prevent re-infection, sprinkle two capfuls into each pair of footwear. Shake to dispense powder evenly. After this, no further treatment should be necessary.

HAMMER TOES\CURVED TOES
Hammer toes and curved toes are caused by a variety of things, including ill-fitting shoes or a muscle imbalance that causes the end joints of one or two (or more) smaller toes to bend. Joints may stiffen permanently in this awkward position. Where the hooked toes rub against shoes, painful corns and calluses, redness, and swelling often develop. Medical attention is necessary if pain persists. Correcting the muscle imbalance with a metatarsal pad or bar may bring relief. Surgery may be required if all other measures fail.

When a toe crosses over or under an adjacent toe, it's a curved (deviated) toe. Dr. Arminio may release the soft tissue to reposition the toe or reconstruct the toe joint. These treatments are often done at the same time.

Surgery flattens and straightens the affected toes by removing a piece of bone or releasing (cutting) a tight tendon. A stiff wire may be used to keep the bones in line while they heal. A postoperative shoe is often used.

• Straightening the toes: Removing parts of the raised bone helps straighten the curved toe. A pin may be inserted to keep the remaining bones straight as they heal. (The pin is later removed.) Sutures close the incision, and a dressing is applied to the forefoot. Healing may take 4 weeks or longer.

• Removing the bone: In this procedure, part of the bone that is rubbing the corn is removed. (Sometimes a pin is used to connect the remaining sections of the bone. It is removed during recovery.) Afterward, sutures are applied, and a dressing is put into place. Healing may take 6 weeks or longer.

• Repositioning the toe: To straighten the toe, Dr. Arminio releases tight ligaments and tendons around the toe. After surgery, a pin may be inserted to hold the bones together, but it is later removed. Sutures and a dressing are placed on the forefoot. Healing may take 8 weeks or longer.

GANGLIONS
A ganglion (a fluid-filled sac near a joint or tendon) feels like a small, painful bump on your foot. Often, before surgery is attempted, Dr. Arminio may remove the fluid from the ganglion to reduce swelling. If you continue to experience symptoms, the ganglion is removed.

To eliminate your pain and other symptoms, the ganglion is removed. Sutures are put into place, and a dressing is placed over the forefoot and, depending on the location of the ganglion, the ankle. Healing usually takes 3 weeks or more.

BONE SPURS
A bone spur (small, bony outgrowth) may irritate nearby soft tissue and cause pain. Bone spurs usually develop in the midfoot and hind foot, but can occur anywhere in the foot. Dr. Arminio may remove the bone spur causing your symptoms.

• Removing the spur: The bone spur is removed to eliminate the source of irritation. After surgery, sutures are put in place, and a dressing is applied to the foot and ankle. Healing may take one month or more.

• Heel Spur: A heel spur is a bony outgrowth at the base of the heel bone near the plantar fascia. A spur may cause pain on the bottom of the heel when you stand. As with plantar fasciitis, the pain may decrease after standing or walking a short time. The pain you feel is not from the spur itself. Your heel hurts because the spur pinches a nerve or presses against the plantar bursa. If the bursa becomes inflamed (bursitis) it may squeeze the plantar fascia.

ATHLETE'S FOOT
Athlete's foot is a common fungal infection of the feet usually occurring between the toes.

What causes athlete's foot?
It is caused by a fungus that becomes active when exposed to a warm and humid environment or when there's a change in the condition of the skin. Athlete's foot is not found just in locker rooms - any moist environment will harbor fungi. Shoes and socks provide a good breeding ground because they tend to accumulate perspiration and moisture.

How do I know I have athlete's foot?
Symptoms include skin pain, burning and itching, cracking and scaling, and swelling.

WARTS
Warts are skin growths. They can appear anywhere on your feet, but most commonly grow on the soles (plantar warts). Most warts are harmless and benign (non-cancerous), although they can be painful. If untreated, warts can grow to an inch or more in diameter and cover the entire sole of the foot.

What causes warts?
Warts are caused by a virus. Like all viruses, they are contagious and can be spread from one person to another, or from one part of the body to another. Children and teenagers tend to get warts more often than adults. Some people are immune and will never develop warts.

What do warts look like?
Plantar warts are hard and flat, with a rough surface and well-defined boundaries. Most are gray or brown with black pinpoints in the center. If your are unsure about any growth, consult your doctor.

FUNGAL NAIL INFECTIONS
Fungal infection of the toenails is a common health condition, though many people assume it's only a cosmetic problem. If a fungal infection is ignored, it could spread and impair your ability to walk.

Why are my toenails thick and yellow?
Thickened, brittle, discolored nails often indicate a fungal infection. There are other conditions such as psoriasis that can cause changes in nail appearance. Fungal infections may not be painful in the beginning. The nail may begin to show small patches of white or yellowish-tan color. As the infection progresses, it may become brittle and split. As the infection progresses, the nail becomes thicker and deformed and may begin to grow at an angle. Pain may develop as the deformed nail causes pressure inside shoes.

What causes a fungal infection?
Fungi, along with dirt and debris, become trapped under the toenail and penetrate the softer nail bed. Nails attacked by fungus thicken, discolor and may separate from the nail bed or even crumble away.

How is it treated?
Your podiatrist can recommend appropriate treatment, depending on the severity of the infection. Medication is often prescribed. In some cases, surgery may be needed to remove the infected nail.

CORNS AND CALLUSES
Corns and calluses are a thickening of skin where shoes repeatedly press or rub. Corns form on the toes, while calluses may be found on dry areas of the feet and body.

Soft Corns
Soft Corns are really soft calluses. They are found between two toes. Caused by pressure from a bony prominence (called a "spur") on the next toe, they are often caused by shoes that squeeze toes together. Doctor's care may involve surgically removing the bony prominence. The corn then disappears with time.

• Don't use over-the-counter medications to dissolve corns.

• Don't trim or shave corns or calluses. The skin is thin, and infection can attack the bone and joints. You could also damage healthy surrounding tissue.

NEUROMA
Neuroma is the thickening of a nerve in the ball of the foot. It develops when the nerve between two metatarsal heads is pinched and bruised - often caused by wearing shoes with pointed toes or by repeated blows or jolts to the foot. Besides pain in the ball of the foot, there may be a numbness between the two affected toes. Doctor's care is needed if pain and numbness persist. You may be given orthotic supports or a cortisone injections before considering surgery. Surgery may be recommended if you still have pain and the enlarged part of the nerve will be removed.

*New non-surgical treatment available.

ON-Q Pain Buster

What is ON-Q Pain Buster?

On-Q Pain Buster includes a balloon type pump filled with a local anasthetic medicine to treat your pain after surgery. ON-Q works right at the spot where you had your surgery, giving you better pain relief than taking only a narcotic type medicine. With ON-Q, you may need to take less pain medicine.

How does ON-Q Pain Buster work?

The pump is attached to a catheter or catheters (small tube) near your incision site. The pump automatically delivers the medicine at a very slow flow rate. Do not squeeze the pump. The pump has the force needed to deliver the medicine. The pump is completely portable. It may be clipped to your clothing or dressing or placed in a small carrying case.

How long will the medicine last?

Depending on the size of your pump, it may take 2-5 days to give all the medicine. Dr. Arminio will instruct you when to come in for the removal of the pump after your surgery.