Acorn September 1999

A Thursday Full of Foot Surgery

So, I hear you asking, what does a podiatrist do all day? Well, sometimes, quite a bit. This is now Thursday evening and I did four surgeries today in addition to seeing a dozen patients in the office. Let me go over them and see how feet can be made better.

We started at 7:30 at the hospital with a nurse named Ginny. She had a bunion surgery on one foot and a tailor’s bunion and hammertoe repair on the other. A tailor’s bunion is a bony swelling on the outside of the foot just behind the little toe. It was named after the tailoring profession when tailors used to sit crossed-legged and the outside part of their foot rubbed against the floor. A tailor’s bunion and a regular bunion are both fixed with a surgical bone fractures, repositioning of the bones and holding it in place with a wire, pin or screw. As I told you last month a bunion surgery is not particularly painful, and neither is tailor’s bunion surgery. All three of these procedures were performed under local anesthesia with a little sedation administered by the anesthesiologist. General anesthesia was not needed. Ginny was home about noon.

The second surgery, on Theresa, was canceled because of abnormal pre-operative laboratory tests. At a routine pre-operative visit her family doctor found that her thyroid levels were too low for an elective surgery. After a week or two of adjusting her thyroid levels she should get her surgery. Theresa has no motion in her big toe joint and it hurts to walk. The joint is completely worn away. She needs a surgery to replace the joint with a titanium-nickel-chromium replacement. This will allow her to get on with her life without pain in her foot.

Next up was Lena, a17 year old who had a procedure performed at the surgery center. Because she was only 16, and scared, a general anesthesia was used. She has what is usually called an extra bone on the inside of her foot by the ankle. This little bone, the size of a grape, rubbed against her shoe and caused her pain. It was not very difficult to pop this little extra bone out of the foot. Afterwards I put Lina into a plaster splint and she is will get around for a week or so on crutches.

In the mid-afternoon I removed a cyst from the top of a foot. This was Ali, a young mother who found the lump very irritating whenever she wore shoes. Originally I thought it was a fluid filled cyst called a ganglion but I had some doubt when I couldn’t get any fluid out when I tried to puncture it in the office under local anesthesia. We scheduled a time to remove it right in the office. In a surgery that took about 35 minutes the lesion, which looked like a dried-out ganglion, was removed and sent to the laboratory for analysis.

The final surgery on Deanna was also performed in the office. It is one I am particularly happy with and few others around here perform it. It is done for heel pain when heel elevation, ice therapy, orthotics, stretching, exercise, injections of cortisone and oral anti-inflammatory medications fail. It involves a partial cutting of the ligament that runs from the toes to the heel called the plantar fascia. Inflammation of this structure, called plantar fasciitis, is one of the most common reasons a person hobbles into a podiatry office. Ninety-nine percent of the time patients get over plantar fasciitis without surgery. When conservative therapy fails, surgery may be the answer. Usually the surgery is rather involved with a 2 to 3 inch incision on the side of the heel. Mine is different. I use a tiny 1/8" hole to advance a tiny little blade and cut a few of the fibers of this ligament. If Deanna is like my other plantar fascia surgeries, she will be back working in just a couple of weeks.

Add to these the dozen patients I saw and it was a typical busy Thursday. Which is a lot like a busy Friday, which, … well, you get the picture.