Surgical

foot surgeon portage indiana

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Foot

HEEL SPUR/PLANTAR FASCIITIS PAIN
This is a very painful condition, possibly the most common foot complaint seen in industrial areas such as Northwest Indiana where people spend a great deal of time working on concrete surfaces. The 26 bones in the foot have to function as a shock absorber and as a propulser, both different and separately with each step. The plantar fascia, which means “bottom elastic” in English, is basically a rubber band that attaches on the bottom of your heel and runs to the five toe joints. Its job is to not allow the foot to over collapse the arch and pull the foot back into rigid position before propulsion. If the 26 bones you inherited don’t function as well as they should, this fascia will be microscopically stretched and will sustain very tiny microscopic tears throughout your life. These tears will be so small that you won’t recognize or feel them, however, they take eight weeks minimum to heal and during that time the same pathomechanics that caused the tear continues to aggravate during its healing and causes scarring. Eventually these tiny microscopic islands of scar tissue accumulates in the fascia and it no longer looks like the 3 mm thick flexible rubber band that it was when you were younger-it usually is about 6 mm thick when patients experience symptoms-which makes it 100% thicker and scarred. When the patient sits down, stands still, sleeps in bed for hours, or drives for any timeframe after walking or working and then gets up and begins walking again, the fascia refuses to stretch, and the weight of your body forces it and it tears the wallpaper off the underside of your heel microscopically which creates excruciating pain and over time will generate a heel spur.

This is easily the most frequent new patient complaint that presents in our office, and can be treated conservatively, non-surgically. We have the technology to evaluate and diagnose with digital weight-bearing radiographic evaluation, ultrasound of the soft tissue fascia and FluoroScan to confirm the alignment of the rear foot joints. Flexible strapping of the arch and anti-inflammatories followed by casting for custom orthotics-arch supports-after confirming that your insurance company covers them-and the patient usually is back feeling much better within a week and working and playing pain-free. With our thorough diagnostic testing, we find that most patients’ insurance companies cover orthotics on a regular basis. Of course, we will do all of the precertification with your insurance as a courtesy to you the patient.

INGROWN TOENAILS
This is a very common and very painful problem affecting people of all ages, with sometimes serious complications if infection occurs. Because of the proximity of the tendons which control the toe and their attachment to muscles in the leg, the tendon sheath can function as an elevator, if you will, directly connecting the infection in the toenail to the muscle in the leg. If conditions are right, this can have devastating consequences. The nail can become infected due to improper trimming or more commonly secondary to genetic development and the shape of the nail and toe.

The important thing to remember here, is that this problem can be treated in the office-PAINLESSLY AND PERMANENTLY RESOLVED-with a minor procedure performed under local anesthesia administered painlessly in the office and lasting for 24 hours to ensure a PAINLESS RECOVERY.

MOST PATIENTS ARE ABLE TO RETURN TO WORK THE NEXT DAY WITH NO RESTRICTIONS AND NO PAIN AND A 98% GUARANTEE THAT THE CAUSE OF THE PROBLEM HAS BEEN ADDRESSED PERMANENTLY

PLANTAR WARTS-VERRUCA
These are very common and very annoying and very painful lesions usually found on the weight-bearing surfaces of the foot, associated with puberty, hormone fluctuations and stress. They are caused by a very common virus which resides on the skin of most people and needs the right conditions, mainly stress on the immune system to allow the virus to replicate in the skin and create a wart. Therefore, we commonly see this problem in puberty aged young people.

If the warts are are small they can be treated with topical application of medication. It should be remembered that they like irritation and friction and therefore treatment with topical should be reserved for small lesions only. If the number or size of the lesions is large, then painless laser hyfrecation under gas sedation at the surgery center, under local anesthesia, achieves an excellent result with one day off work or away from school.

BUNIONS-HALLUX ABDUCTO VALGUS
A bunion is any deformity that affects the great toe joint. It can manifest as a horizontal deviation where the great toe pushes against the second toe and a large red painful bump appears on the inside or medial aspect of the great toe joint. It can also manifest as a vertical plane deformity where a large bump of bone develops on the dorsal or upper aspect of the great toe joint limiting the range of motion and creating pain when walking as well as wearing shoes.

The cause for either one of these is a mechanical instability at the joint, caused by genetic instability in the joints of the foot. It is extremely important to address the cause of the problem conservatively with an arch support, otherwise, even if surgically repaired, the problem can return if the patient lives long enough.

It is always best to have this evaluated and diagnosed appropriately not only as regards the bunion deformity but the biomechanical cause- and treat both of these problems.

If surgery is required, it is almost always an outpatient procedure and with most surgeries if treated appropriately can result in excellent recovery and very little postoperative pain.

HAMMER TOES
Hammer toes are a deformity associated with the closest of the two joints in the toes to the foot. The purpose of the toes are to grab the ground when we initially hit the surface to give us stability and then to extend and become a lever arm during propulsion to help guarantee that we propel straight ahead. Again, if the biomechanical stability of the foot is less than perfect, the toes will grab the ground longer and harder to help stabilize the foot and this will result in eventual shortening of the ligaments and tendons and the patient will have toes that stay in a clawed position resulting in discomfort from shoe gear and increasing instability during gait.

Again the pathological mechanical cause of the problem needs to be recognized and addressed to turn off the cause and then depending on the severity of the deformity they can be treated. Most patients recognize a remarkable increase in their stability and confidence when walking after hammertoe correction. The deformity occurs so slowly over so many years that the loss of stability when they walk is insidious.

FLAT FEET/EXCESSIVE PRONATION
The foot has two functions and they must be performed with each step. Absorbing shock is the first step and with a very flexible hyper prone aiding-flatfoot-this job is performed almost too well. The arch collapses excessively, the foot actually torques inward and the leg rotates internally more than it should. The foot now cannot become rigid for propulsion and body momentum forces the foot to propulse in this flexible unstable position and this causes almost all 33 joints in the foot to sustain abnormal tension, compression and twisting. Over time, this will create bunions, hammertoes, heel spurs, plantar fasciitis, ankle damage and further up the leg – the medial meniscus will be worn almost completely by age 45 and the pelvis tilts forward to help the ball and socket joint at the hip allow the leg to do this abnormal inward rotation and that causes low back pain.

All of this can be avoided-in spite of the patient age-with a very small implant and a 35 min. surgical procedure which is basically painless. Patients can walk on the foot at one week postop and will immediately notice that they have a”new” foot.

Dr. Fedorchak has personally done this surgery on over 1400 patients and it continues to be his favorite surgery-because I have told every parent of the patient and every adult patient that the surgery can be 100% reversed if they don’t like it. We have never had to do that. But it certainly is a wonderful thing to tell parents that you can change their child’s foot dramatically for the better and they have very little to fear from the surgery because it can be reversed. Dr. Fedorchak has even done this surgery on his own oldest daughter when she was 4 1/2 years old. Patients in this practice age from 4 1/2 years old to 75 years old and have delighted in the benefits of this surgery.

HIGH ARCH/CAVUS FOOT
People who inherit a very high arch tend to have the chronic complaint of feeling as if they have “weak ankles”-because the foot lands in such an abnormal lateral heel position that the ankle is exposed and suffers microscopic sprain with every step which ultimately causes chronic damage to the lateral ankle ligaments as well as the ankle joint. Additionally these patients quite often suffer from dramatic hammertoe deformities and bunion deformities because of the forefoot’s attempt to grab the ground with each step and make up for the loss of stability suffered by the hyper rigid foot. The real problem here is the rigidity, which steals the shock absorption function from the foot and causes 150% of what the patient weighs to be transmitted up into the ankle, knee, and hip and lower back and create severe degenerative arthritis at an early age.

This is a foot that needs to be addressed conservatively at least and probably surgically and there are ways with outpatient surgery to bring this foot around to a normal function. One of the first things that needs to be done with this foot-is utilization of external shock absorption shoes to prevent the severe damage to the ankle, knee, hip and lower back joints from the foot’s inability to absorb shock.

Quite often these patients are very good at sports and running and therefore feel that the rigid foot is a blessing-it comes with a high price.

RHEUMATOID ARTHRITIS-RA
Rheumatoid arthritis is one of several diseases considered at this time to be called connective tissue disorders. Medicine is still not sure where to put these diseases and so they are lumped together. The common denominator is that the body attacks itself. The immune system cannot differentiate between bad external invasion and the internal makeup of your body. In the case of rheumatoid arthritis it attacks the ligaments in joint capsule which are the stability for the joints. If these are attacked and damaged than abnormal range of motion is allowed and that creates structural damage to the joint cartilage and visible deformity to the patient. It is also extremely painful.

Every rheumatoid arthritis patient should have a custom functional orthotic. The disease weakens and destroys the structural integrity of the joints and then secondarily the joint cartilage becomes damaged and extremities become deformed. With 1 1/2 times what you weigh coming down on your foot with every step you take, you need all the support you can get. If your body is destroying some of that natural support through damage to the ligaments and joint capsule then external orthotic support is absolutely necessary to prolong alignment and limit pain.

FRACTURE TREATMENT AND REPAIR
Fractures of the toes, the foot and ankle all come in varying degrees of severity. Some of them can be so mild as to require simply a shoe gear modification. But others can be much more devastating.

First of all it is important to see a specialist of the foot and ankle to ensure that all anatomic and physiological function of the fractured bone is understood completely from a weight-bearing standpoint as well as the location of tendon attachments. If there is a tendon attachment close to where the fracture has occurred, and the emergency room doctor is not familiar with the anatomy of that attachment it could have devastating effects as the fracture will move during the healing process-4 to 6 weeks-and can seriously distract from the healing. This can end up in abnormal bone formation, chronic pain, and failure of the fracture to heal.

Also location of the fracture as regards joint surfaces can be very important to long-term impact and excellent healing. This is very commonly seen in the midfoot, rear foot and ankle, where emergency room and urgent care physicians may not appreciate the severity of the damage or even have the equipment-FluoroScan and Ultrasound-to evaluate the fracture location properly.

Sometimes, the severity and location of the fractured mandate that conservative therapy i.e. cast and crutches will not be enough and surgical intervention Open Reduction Internal Fixation-the use of screws and plates-becomes necessary to ensure proper alignment and proper joint function and preservation of the joint. Quite often a fracture through a joint can be missed and becomes devastating later.

POSTERIOR HEEL PAIN-ACHILLES TENDON INSERTION BUMP-“PUMP BUMP”-RETRO CALCANEAL EXOSTOSIS
This is a very painful bump of bone which gets larger with time at the insertion of the Achilles tendon on the back of the heel. Quite often it is associated with a curvature of the heel-calcaneal varus-which creates an abnormal pull on the Achilles tendon insertion on the back of the heel bone-calcaneus-and causes bony overgrowth and pain and eventually inability to wear certain shoes and to walk.

Like most bio mechanically caused problems in the foot and ankle if addressed early with proper diagnosis and conservative non-surgical treatments such as orthotics it can be slowed or completely stopped in its natural progression.

Sometimes, due to severity or to the amount of time it has been allowed to grow, surgical repair is necessary and can be performed on an outpatient basis.

ANKLE JOINT RECONSTRUCTION
The Ankle Joint is one of the most unusual and difficult to understand joints in the body. In mechanical terms it could be referred to as a universal joint-because it allows range of motion in all three planes and it allows motion in these planes simultaneously. This makes it a very, very difficult joint for the body to stabilize and a very susceptible joint to damage.
It should be evaluated, diagnosed and treated only by someone who is Board-Certified in Ankle and Lower Leg Reconstruction. There are very few Podiatrists in Northwest Indiana who have those qualifications. This office is one of them.

Dr. Fedorchak is Board-Certified in Ankle Reconstruction Surgery, Ankle Fracture Surgery and Treatment, Lateral Ankle Ligament Stabilization and surgical repair, Bony Block Reconstruction of the Ankle and Osteochondral Defect Repair of the Talar dome and Tibial plafond-the ankle joint.

ACHILLES TENDON RUPTURE AND REPAIR
The Achilles tendon is the largest tendon in the body and is required to create enough force to lift your body weight multiplied by 150%, off the ground with every step you take.

Tendinitis and partial tears as well as complete rupture of the Achilles tendon need to be diagnosed and evaluated by an expert .

Quite often slight tears, tendinitis, etc. can be treated conservatively with below the knee cast for six weeks

If surgical repair is necessary it should be performed by someone who is Board-Certified and does this kind of surgery on a regular basis-Dr. Fedorchaks’ office provides that quality of care

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