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

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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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