Surgery Information

Dr. Brian Richman's Web Site Podiatric Medicine, Surgery, and Diabetic Foot Problems

Surgery
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There are many procedures and techniques for foot and ankle surgery, listed below are the most common. Every patient is different, each having a unique problem. Every patient should be treated for his or her specific condition. That is the art of medicine. These are general statements and should not be considered standard of care. You and your physician should determine what is the best medical treatment for your podiatric condition. If you would like to know more about each procedure or technique go to the physician section at this web site.

Podiatric Medical Condition	Consider Surgical Procedure
1. Ankle Joint - Inflammation (Synovitis), Gout, or Arthritis	- Ankle Arthroscopy
2. Ankle/Foot Fractures - A. If stable fracture and in good alignment B. If fracture is unstable, mal-alignment C. With any fracture your goal is to have a stable fracture, with good range of motion, and good alignment. All three helps in bone healing. Fractures usually take 6-8 weeks to heal.	-Consider closed reduction - Consider surgery (ORIF) (Open Reduction Internal Fixation) plus immobilization
3. Ankle Instability - Inversion sprains are common	- Lateral Ankle Stabilization
4. Achilles Tendon Rupture - Usually associated with trauma	- Achilles Tendon Repair
5. Tendon Rupture - Usually this is the Posterior Tibial Tendon or the Achilles Tendon	- Surgical Repair
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6. Achilles Tendon Contractures - Usually associated with Cerebral Palsy, Neuromuscular disease, Clubfoot, Burns, Trauma	- Achilles Tendon Lengthening
7. Ankle/Foot Soft Tissue Mass - Ganglionic Cysts, Lipomas Neuromas, Fibromas, Warts, Tumors, Inclusion Cysts, etc. A. Most soft tissue masses in the foot or ankle are benign, some soft tissue masses are malignant or have the potential to become malignant. I believe all soft tissue masses should be sent to pathology for examination. it is beyond the scope of this web site to cover all soft tissue masses.	- Surgical Excision & Biopsy
8. Tarsal Tunnel Syndrome - Nerve entrapment similar to Carpal Tunnel Syndrome in the wrist.	- Tarsal Tunnel Release
9. Bunions - There are many types of bunions and many different procedures	- Bunionectomy (See Physician Section)
10. Hallux Limitus - Decrease Range of motion 1st MPJ	- Cheilectomy (remove spurs around joint) - Decompression Osteotomy (like a Bunion procedure) - Arthrodesis (Fusion) - Implant
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11. Tailor's Bunions - 5th MPJ area, sometimes called a bunionette	- Tailor's Bunionectomy
12. Hallux Fusion - Good for foot where Hallux has difficulty clearing the Ground. (i.e., Stroke patients, neuromuscular diseases, hallux hammertoe.	- Hallux Arthrodesis - fusion of the big toe use in conjunction with Jones Tenosuspension (Tendon transfer 1st metatarsal)
13. Hammertoes - Sometimes called clawtoes, mallet toes	- Hammertoe Correction (Arthroplasty ) removal of bone usually at the joint
14. Contractures - metarsal Phalengael joints usually associated with hammertoes	- Tenotomy / Capsulotomy (Surgical Release)
15. Diabetic ulcers - (New techniques see my section on diabetes)	- Surgical Correction
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16. Diabetic Infections - Serious and need to be treated aggressively and quickly	- Incision & Drainage with IV antibiotics
17. Diabetic Amputations - These are usually a result of infection, ulceration, peripheral vascular disease. many amputations can be avoided with regular medical care, early intervention, and appropriate treatment.	- Surgical Correction (See Diabetic Section)
18. Charcot Foot - Usually breakdown of the midfoot or rearfoot. Common in diabetics, neuropathy conditions	- Achilles Tendon Lengthening - Fusions - Exostectomy
19. Exostosis - (Bone Spurs) Achilles Tendon insertion area, Calcaneal Spur, Dorsal (top of foot)	- Exostectomy
20. Nerve Entrapment - Usually associated with scar tissue	- Nerve Resection
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21. Foreign Body Removal - These are usually stepping on a piece of glass, needle, toothpick, thorn, or painful hardware	- Surgical Removal
22. painful Keratomas - Usually nucleated callouses causing pain secondary to depressed metatarsal	- Surgical Correction (Oblique Osteotomy)
23. Flatfoot Problems - usually can be treated conservatively	- Young's Tenosuspendion (Flatfoot proceedure - Fusions
24. Plantar Fasciitis - Heel pain with or without heel spur	- Plantar Fasical Release (open) or endoscopic technique
25. Ingrown Toenails - Painful, usually treated in office	- Partial Nail Avulsion (temporary procedure-cutting out the sides of the nail)
26. Thick painful Toenails - Painful, usually treated in office	- Total nail Avulsion - Total Matrixectomy
27. Pes Cavus Reconstruction - High arch foot, sometimes associated with neuromuscular disease	- Multiple Procedures are needed to correct this foot type
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American Podiatric Medical Association	Joslin Clinic at Harvard Medical Center	A B P O P P M B O A R D C E R T I F I E D American Board of Podiatric Orthopedics & Primary Podiatric Medicine	American Diabetes Assocication
^thePodiatrychannel		Member of the Utah Podiatric Medical Association	UTHSCSA