Bunion surgery is not what it used to be. New procedures and fixation techniques have allowed patients to move to a special surgical shoe or walking boot for physical therapy right away, with full recovery possible in just six weeks. As fellow surgeon Dr. Luke Cicchinelli from Arizona put it: “Bunion surgeries have been performed for more than 100 years. Techniques used today ensure minimal pain, earlier and improved mobility, and decrease the likelihood that a bunion will return later in life.”
There is still a divide among foot and ankle surgeons as to whether to send bunionectomy patients immediately to physical therapy or to advocate a period of “taking it easy.” Here at The Center for Podiatric Care and Sports Medicine in NYC, we have seen great results advocating post-surgery physical therapy. Today we’ll discuss the three main benefits of early weightbearing following bunionectomy.
Seventy-five percent of New York State Podiatric Medical Association members say they’ve diagnosed melanoma or skin cancer during a routine foot examination. While it’s great that podiatrists are alerting patients that they have a serious health problem, the prognosis is not usually good. Once cancer reaches the feet, the condition has already progressed to an unhealthy level. When cancer remains undetected for years, the five-year survival rate drops down to about 50%, so it’s best to take proper prevention steps sooner rather than later, say the podiatrists at The Center for Podiatric Care and Sports Medicine in Manhattan.
Last June, we wrote about the Philadelphia 76ers’ #1 draft pick, Joel Embiid, and the navicular stress fracture he sustained in his right foot. For a prospect with great defensive skills who had been compared to greats like Tim Duncan and Hakeen Olajuwon, this foot injury was very bad news. The center underwent foot surgery with two plates and screws inserted, as many players do; but once the hardware’s in, there is no predicting what will happen. One hopes for the best and plans for a four to six month recovery, but each individual body sets its own agenda for healing. Coaches opted to play it safe and keep Embiid out for the whole season, rather than rush him back to the game. This week, news surfaced regarding Embiid’s progress — but it was not what fans wanted to hear.
Where do you spend your evenings after work? Most people would never dream of saying, “At the orthotics store!” Yet, SOLS, a new brand of 3-D custom shoe inserts, is revamping the industry image for the orthopedic device with “Martini Mondays,” live DJ sessions, and candlelight yoga classes at their NY shop in Bowery. “We are trying to make orthotics sexy,” explains VP of Marketing Joy Altimare. “We’re not just an orthotics company, we’re a lifestyle brand.” The Center for Podiatric Care and Sport Medicine has been working with SOLS for more than a year. Our very own Dr. Josef J. Geldwert serves as a biomechanics advisor to the company.
Toenail fungus is one of the most insidious conditions among patients seeking podiatric care. Though the exact incidence of recurrence is not known, rates as high as 53% have been reported, indicating that more than half of all toenail fungus patients suffer from chronic infections that don’t seem to go away, even after seeking treatment. Part of the problem, say New York podiatrists at The Center for Podiatric Care and Sports Medicine, is the ease of re-infection by coming into contact with more of the fungus adulterating the patient’s daily environments.
“It’s easy to see how toenail fungus becomes a chronic problem when you consider the reproduction of fungal colonies,” explains Dr. Katherine Lai, DPM. “Tiny microscopic fungal spores contaminate everything from towels and bed sheets, to socks and shoes. Therefore, effective treatment relies on attacking the root cause, but also addressing issues of cross-contamination.”
The Achilles tendon is a terrible body part to rupture, with many players never returning to full strength after such an injury; but that didn’t stop the St. Louis Cardinals from taking a gamble on Kep Brown, who St. Louis Todaydescribes as “a 6-foot-5, 210-pound power high school hitter from Wando High School in Mount Pleasant, S.C.” At the time of his injury, he was batting .517 and was considered a first to third-round pick.
Though Brown tore his left Achilles tendon in the 13th game this season, scouting director Chris Correa says it’s worth the risk. “He’s big and strong, and he might have the most power of anyone we drafted in this class,” said Correa. “I don’t think there are a lot of guys with more power potential in this draft than Kep Brown,” he added.
The Cardinals are no stranger to Achilles ruptures; they lost starting pitcher Adam Wainwright with an Achilles tendon injury on April 25th. Wainwright underwent surgery to repair the torn tendon, which fortunately, went without a hitch. The ends of a torn tendon look like the strands of a mop and sometimes do not align perfectly, and additional materials are needed to attach the pieces together. This was not the case for Wainwright, who is expected to recover in nine to 12 months, just in time for 2016 spring training camp.
What Happened To Kep Brown?
The Post and Courierhas kind words to say about the young Kep Brown. “The Wando High School outfielder, big and strong at 6-5 and 200 pounds, had burst on to the national scene last summer, slugging baseballs over fences at national showcase events to make himself one of the most highly rated high school hitters in the country,” they report. In his final high school season up until his injury, he had hit six doubles, a triple, and two home runs and maintained a 1.000 slugging percentage. “He was going to have a special season,” said coach Dirk Thomas.
Brown, playing right field at the time, leaped into the air to give an enthusiastic fist-pump celebrating a spectacular catch by teammate Harrison Smith. Upon landing, he immediately knew something was wrong. “I felt it pop,” Brown told The Post and Courier. “I bent over like I was tying my shoes and felt it. I knew something was wrong.” Angered by what had happened, he uttered some choice words and threw his baseball equipment in disappointment and disgust. It seemed he had not only let his team down, but hurt his draft prospects as well.
Yet, Brown’s coach said he has displayed tremendous grace and maturity throughout his recovery. “My tendon is still tight and will be for a while,” Brown admitted. “But the best part of my day is going to rehab and getting it loose and getting it worked out. The doctors and people at physical therapy are amazed at my progress.”
How Are Achilles Tendon Ruptures Treated?
In the past, there was much more ambiguity about how to treat a ruptured Achilles. Conservative treatment using non-weight-bearing casts followed by physical therapy used to be the standard protocol. Now we know that, for dynamic athletes with advanced or complete tears, the best course of action is surgical intervention. Surgery is associated with a lower rate of re-rupture, according to Lower Extremity Review Magazine. Research shows that early range-of-motion exercise prove especially beneficial for regaining mobility and strength to return to competition as soon as possible.
The usual duration of recovery is a minimum of six months, with a year the most likely timetable. The initial period of “taking it easy” typically stretches for a solid four months. Anti-inflammatory medication, massage, and gentle stretching can be employed during this time. Later, low-impact exercise like swimming and walking with an orthotic insert can be done to maintain some level of physical fitness. Finally, a physical therapy program of strength-training, stretching and flexibility exercises helps the player develop full functionality again.
NYC Achilles Tendon Injury Rehabilitation
The Center for Podiatric Care and Sports Medicine in NYC treats baseball players and other athletes with Achilles tendon injuries using all the latest techniques geared toward a successful recovery. We employ experienced board-certified podiatric surgeons with extensive experience in Achilles tendon reconstruction, as well as a full team of physical therapists who guide athletes through recovery. When necessary, we offer complementary therapies like extracorporeal shockwave therapy, MLS pain lasers, and platelet-rich plasma injections, which reduce discomfort and facilitate natural healing mechanisms. Contact us for more information.
NY podiatrists perform a comprehensive examination of all body systems to get to the root of your foot problem. So it’s no surprise that podiatrists are often the first doctors to diagnose afflictions such as arthritis, diabetes, thyroid or peripheral artery disease. Foot doctors sometimes order further tests like x-rays, CT scans, MRIs, or blood studies.
“Foot doctors are often overlooked as patients set up a primary medical care team,” says Dr. Josef J. Geldwert, DPM. “Yet, we work closely with primary care physicians, dermatologists, cardiovascular specialists and neurologists in the diagnosis and treatment of diseases that manifest themselves in different ways — including tell-tale signs in the feet.” He explains that the first goal of his podiatric team is to conduct a thorough assessment and obtain an accurate diagnosis. From there, they seek to immediately rectify the patient’s pain and suffering, and then treat the root cause of the issue.
Here are 10 of the most common undiagnosed diseases the team at The Center for Podiatric Care and Sports Medicine come across in New York City.
Achy, sore feet is one of the most common complaints in the podiatrist’s office. So many New Yorkers spend the entire day on their feet, so it’s no wonder they encounter soreness on a regular basis. When you are standing, there are two strong forces: ground contact pushing up from below and weight bearing down from up top. Standing for long periods of time strains the circulatory system, causing muscle fatigue and inflamed veins. Constant pressure can cause bone misalignment, tendon strain, and joint degeneration over time.
When you walking, a myriad of other factors come into play during a typical gait cycle, which moves from heel contact, to load bearing, to push off. Most damage occurs transitioning from the contact to load-bearing phases, as the foot may roll inward or outward excessively to accommodate the increased weight. This may shift the knees, hips, pelvis and spine out of alignment, causing a spiral of pain all over the body.
This complexity is why it’s best to come in and be evaluated by one of our board-certified podiatrists and sports medicine doctors in New York City. In addition to having all the basic podiatry tools, we also have a state-of-the-art computer gait analysis center to detect any abnormalities or natural tendencies in your gait that contributes to the pain you are suffering. Unlike a general practitioner that is more inclined to offer medication that treats the symptoms, we determine the root cause and deliver a more comprehensive treatment for foot pain. We love to share our expertise with patients who come in full of questions. Here are a few answers to some common inquiries in the meantime…
Last week, the Yankees were on the edge of the seats, wondering if heavy hitter Brian McCann was seriously injured. He left in the eighth inning on the May 24th match-up against the Rangers when his arch began to cramp. He started as usual on Wednesday but left after the second inning when pain in the bottom of his foot crept up his calf and became unable to bear weight. McCann worried that the pain was symptomatic of a dreaded Lisfranc injury — the displacement of the midfoot joints, which can take upwards of a year to heal or may never return to normal.
The board-certified podiatrists and sports medicine doctors from The Center for Podiatric Care and Sports Medicine in NYC treat amateur and professional athletes with foot pain and dysfunction, including Lisfranc injuries. “Lisfranc was a good guess,” said Dr. Ryan Minara, DPM. “Usually we see some bruising with Lisfranc sprains or fractures, but it’s good to see the Yankees are taking their players’ health very seriously and sending their players in to get the diagnostics they need.”
Another concern was that he may have plantar fasciitis. While it’s often referred to as “heel pain,” most plantar fasciitis sufferers suffer tremendous pain in the arch and have cramping that extends up into the leg. “Often, plantar fasciitis patients experience the worst pain first thing in the morning or after prolonged standing or running. If McCann says his flare-ups happen when he’s catching, I’d be inclined to say it’s not likely plantar fasciitis,” explains Dr. Minara.
Truly, the only way to know for sure is to get an MRI or CT scan, which McCann did last Thursday.
Determining the correct shoe size is challenging enough as an adult, with more than one size fitting your foot to varying degrees. You may wear different sizes depending on the brand or shoe style. Yet, sizing a baby is a whole other animal when you’re struggling with a wriggling little one who can’t say whether the shoe fits comfortably or not. It can also be terribly difficult to keep a shoe on a child’s foot, whether it fits or not! Most questions about baby footwear are deferred to pediatricians, but if you are a patient at The Center for Podiatric Care and Sports Medicine in NYC, we invite you to bring us your questions about your infant’s shoes as well. Here are some general guidelines to consider.
“I am so grateful for having had Dr. Geldwert perform bunion surgery on both of my feet. I have complete confidence in him and continue to see him for other sports related injuries. I was cautious about having surgery for the first time, but his knowledge, patience, and skill made me completely comfortable in trusting him. And I couldn’t be any happier with the results!! When anything else feels wrong with my feet, I love that I now know to go immediately to him. He is my top choice for anyone searching for the best foot fixer/surgeon/sports doctor in NYC! Thank you, Dr. Geldwert!!!”
– J. M., Manhattan, NY
Manhattan Office 111 East 88th Street New York, NY 10128 (212) 996-1900 See map here
Westchester Office 10 Mitchell Place Suite 105 White Plains, NY 10601 (914) 328-3400 See map here
Manhattan Orthopedic and Sports Medicine 57 West 57th Street New York, NY 10019 (212) 996-1900 See map here
Dr. Josef J. Geldwert DPM, Dr. Katherine Lai DPM, Dr. Ryan Minara, DPM, and Dr. Mariola Rivera DPM serving Westchester County, White Plains, Ardsley, Bronxville, Harrison NY, Larchmont, Mamaroneck, New Rochelle, Rye, Scarsdale, Rye Brook, Chappaqua, and the surrounding area.
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