MIS Bunion - Minimally Invasive Bunion
61 year old female with a painful bunion. With over 100 procedures available it can be quite challenging for patients to decide on the right procedure and right surgeon. I perform the Minimally Invasive Surgery (MIS) Bunion procedure since it has excellent results and the procedure itself provides faster recovery with less pain. Risks of the MIS include hardware pain, nerve injury or paresthesia and wound infection, but these risks are likely with any procedure. Below are pre and post surgical pictures of her foot at 1 year out.
Minimal Scar Appearance!
Minimal Surgical Scars!
Chronic Ankle Instability
41 year old male with chronic ankle instability from a nonunited avulsion fracture. Underwent modified Brostrom internal brace of his Anterotalofibular (ATFL), Calcaneofibular (CFL) and excision of avulsion fracture. Doing great at 2 weeks, these are his 2 week postoperative photos! Plan to have him start Physical Therapy in 1-2 weeks, if doing well will medically clear him to return to all activities in 4 weeks!
2 weeks after ankle stabilization via Brostrom Internal Brace!
Haglund Deformity (AKA Pump Bump)
This is a 48 year old male who underwent a traditional open Haglund resection on the right by another provider. His recovery was 1 ½ years. On the left, I performed a Minimally Invasive Haglund resection, he was back to biking in 6 weeks and running with no pain at 3 months.
Ankle Fracture Surgery
76 year old female with a trimalleolar ankle fracture dislocation. She is 3 months from her minimally invasive ankle fracture fixation. No pain, walking with no limp and is very pleased with her recovery and outcome. She is now back to her daily walks and just recently retired and is now ready to enjoy herself!
Walking pain free after her surgery at 3 months!
Ankle Arthritis
65 year old male with advanced ankle arthritis. Prior history of breaking his leg that healed malaligned. Underwent Total Ankle replacement using the Wright Medical Prophecy Infinity Adaptis implant. He is 8 weeks out from surgery, doing exceptionally well, back to biking and walking without pain. We cleared him today to return to flying his planes!
Midfoot Arthritis
73 year old female with end stage midfoot arthritis. She had tried all conservative measures to include modified activities, steroid injections, shoe inserts but was having life altering pain in her foot. Underwent midfoot fusion (ie, Arthrodesis of 1st to 3rd Tarsometatarsal joints) with stem cells/platelet rich plasma, calcaneal bone autograft. We used nitinol compression plates & staples with titanium headless screws.
For midfoot fusions, the acute healing is 3 months but overall it is a year long recovery to get to the best of the best. After 6 months, she is back to her daily walks with her husband and is very pleased with her results. Her foot is doing great!
Achilles Treatment
32 year old male who ruptured his right Achilles, after a thorough discussion we opted to treat his Achilles rupture conservatively using functional rehabilitation and two PRP (platelet rich plasma) injections. He is currently 6 months out and is doing well. The ultrasound shows a completely healed Achilles tendon and the muscle contour/bulk is returning.
Neuroma
69 year old female with a painful neuroma. She had tried all conservative options (eg, orthotics, steroids, modified activities, neuroma pads) but was still having pain. Underwent neuroma excision and is 6 weeks out. She is doing well but has some soreness in the forefoot.
Typically, neuromas are common in the 3rd interspace (ie, between the 3rd and 4th toes). Surgery, when indicated, is usually performed with an incision on top of the foot. To access the neuroma the intermetatarsal ligament has to be incised. This is repaired after neuroma excision but usually is why patients have soreness for a few weeks and even a few months after surgery. Compression socks and orthotics help mitigate the symptoms.
Flatfoot Procedures
19 year old female who underwent “exploratory” surgery for her foot pain but she persisted to have pain and was basically told there was nothing else that could be done. When I saw her for a second opinion it was determined she had scarring of her posterior tibial tendon, torn Spring ligament and underlying flatfoot.
She underwent a Minimally Invasive Medializing Calcaneal osteotomy, Spring Ligament reconstruction with internal brace, posterior tibial tendon repair with Amnion (ie, placental tissue) and stem cells. She is at 6 weeks and we will start her on physical therapy with a partial progressive weightbearing program. Despite these procedures she only used pain medications for a few days and she stated this surgery much less painful than her “exploratory” surgery despite being “more” invasive!
Peroneal Tendon
67 year old male with ankle injury and on MRI found to have a longitudinal split tear of the peroneal brevis tendon. Tried bracing and PT with little relief. Before surgery was decided we tried a single PRP injection. Given the pain improved drastically, we decided to obtain another MRI. To our excitement we could see the tendon has started to heal!
Given his symptoms are not completely gone our plan is to try another PRP injection!
Foot Fracture
76 year old female who tripped and fell. Initially told she had sprained her ankle and given a boot with instructions to walk. When I saw her, the exam was concerning for possible foot fracture, a CT scan revealed a displaced lateral process fracture and cuboid fracture that extended into the joint.
When initial xrays do not correlate with the severity of the exam its prudent to obtain higher imaging studies.
She underwent operative fixation. At 1 year out she is doing well. She has developed some mild post traumatic arthritis but is very tolerable and does not impede her activities. For the mild arthritis we will fit her with a pair of custom orthotics.
Clayton Hoffman Procedure
60 year old male with severe forefoot deformity and pain due to Rheumatoid Arthritis. He had intractable calluses on the bottom of his foot for years making walking difficult despite custom shoes and orthotics. I performed a Clayton Hoffman procedure (ie, 1st MTP fusion, 2-5 metatarsal head resections), he is now 2 months from his procedure. He is back to walking, even last week was doing house work on a ladder, without any pain and wearing normal shoes!
Big Toe Arthritis
Cartiva
70 year old female who had chronic big toe pain. She had failed conservative care and opted to proceed with Cartiva implantation. At 3 years out she is very pleased with her recovery, she has no pain and is very appreciative of her procedure.
Its a great option for people who have advanced arthritis who are not candidates for spur removal and who do not want the other option which is fusion. With fusion there the largest limitation is lack of big toe motion, inability to wear any shoes with more than 1 1/2 inch heel.
The surgical scar is almost invisible!
