FIX MY FOOT

How Can Tibial Hemimelia Be Corrected?

Tibial Hemimelia is not a city in Tibet. It is a leg and foot condition where there is a partial or total absence of the tibia (also known as the shinbone).

It is the rarest form of lower limb deficiency (present at birth) and only happens in one in a million births. This is a big deal because the Tibia is the strongest weight bearing bone in the body.

(photo by rbelding.org)

There are two long bones in the lower leg, the thicker one is called the Tibia and the thinner one is the Fibula. When a baby has Tibial Hemimelia, the Fibula is there, but the Tibia is either missing or misshapen.

There is often a foot deformity and the foot may even have additional toes. If that wasn’t enough, the knee may also be twisted inwards.

Most legs affected by Tibial Hemimelia will look unusual and it can happen in either in one leg or both legs. Thirty percent of the time with Tibial Hemimelia,  both legs have it.  Sometimes the Fibula may also be deformed or unaffected.

Tibial Hemimelia may be discovered when the baby is born or during a routine ultrasound. Treatment of the Tibial Hemimelia by  a foot and ankle surgeon really depends on how severe it is.

For a mild form of Tibial Hemimelia, the Ilizarov apparatus may be used to lengthen the baby or child’s leg and improve the position of the foot.

In more severe cases of Tibial Hemimelia, amputation may be the best option, followed by a prosthetic limb (fake leg), which may be placed above or below the knee depending on the condition of the knee joint.

Some attempts at reconstruction of the Tibia have been made using the Fibula, but this rarely provides a functioning limb because of instability at the knee and problems with the quadriceps (thigh) musculature.

Tibial Hemimelia is a type of Lower Limb Deficiency (LLD). The options for treatment of Tibial Hemimelia  will vary depending on which bones are present, the size and shape of them and any problems in other structures such as muscles and ligaments.

When considering Tibial Hemimelia treatment options for your child, it is important to remember there is not one ‘right’ or ‘wrong’ decision. Parents should never feel pressured into making any quick decisions, but should always have clear unbiased information.

If you child suffers from Tibial Hemimelia, then you need to contact a foot and ankle surgeon who can give you the best course of action for your child.

Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist and find out which is the best option for your child.

What Is Fibular Hemimelia and How is it Fixed?

Fibular Hemimelia is when someone is born with a partial or complete absence of the fibula, which makes their leg shorter and may include deformities the femur, knee, tibia and other foot and ankle conditions.

We don’t know what causes Fibular Hemimelia, but it is not considered to be genetic (passed down from the parents).

(image by orthobullets.com)

For many years amputation has been considered the standard treatment. If someone has a serious lack of ankle stabilization and significant limb length difference, then amputation is still recommended. There are two types of amputation methods used: the Boyd procedure and the Symes procedure.

However, advances in ankle reconstruction and limb lengthening are now an option for less sever cases of Fibular Hemimelia. There are many factors that decide which treatment option is the best choice.

When trying to decide between amputation or limb lengthening, parents would be wise to consult a foot and ankle specialist.

Basically, the main question to ask  is: “Is the foot functional?”

If the foot is not functional, then amputation and prosthetic fitting may be the best course. As horrible as that may sound to parents, keep in mind that even athletes have had this procedure and gone onto the Olympics.

That said, patients with less severe Fibular Hemimelia may undergo successful lengthening and stabilization procedures. Complex surgery for lengthenings is required to protect the foot from further deformity.

There have been studies that demonstrate that children who undergo early amputation are more active, have less pain, are more satisfied, have fewer complications, undergo fewer procedures, and incur less cost than those who undergo lengthening.

There were fewer hospital admissions, clinic visits, and periods of absence from school in children who had the amputation procedure done.

When it comes to limb lengthening, families often have unrealistic expectations of the surgical and prosthetic technology available and may refuse amputation, when this has been recommended, and instead choose limb lengthening.

The good news is that Fibular Hemimelia can be discovered via ultrasound while the baby is still in the mother’s uterus. This gives the parents and their foot and ankle doctor time to prepare for amputation after birth or bone lengthening surgery.

Here are a few interesting facts about Fibular Hemimelia:

• Partial or total absence of fibula is one of the most frequent abnormalities in the legs.
• It is most common long bone deficiency and is the most common skeletal deformity in the leg.
• It most often is present only on one leg.
•  Males have it twice as often as females.

If you suspect your child has Fibular Hemimelia, then a foot and ankle surgeon can give you the best course of action.

Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist and find out which is the best option for your child.

What Is Chronic Ankle Instability?

Has this ever happened to you? Your ankle gives out and it collapses under your body weight. You hit the ground hard with an ankle injury.

People tell you to get up and walk it off. Others are telling you to put ice on it. Others examine it with their unprofessional gaze and then tell you not to worry: “If you can walk on it, it’s not broken.”

(image by thesportsphysiotherapist.com)

So you manage to limp home and get off your foot. A couple of days later, the ankle has become very swollen and painful. It’s all “black and blue.”

Maybe you go to the emergency room or an urgent  care center to have you are ankle injury checked and/or X-rayed.

You are told it’s not fractured and not to worry, it is only an ankle sprain. They put an Ace bandage on it.

You spend the next couple of months dealing with swelling, pain, stiffness, muscle spasms and pain. You tape it, you tie it, you wrap it, you soak it. And finally, it “heals.” Or has it?

In reality, this an ankle that has never properly healed and is left with weakened support, making you vulnerable to chronic ankle sprains and a life of chronic pain.

So why would something like a simple ankle sprain wind up creating chronic ankle instability? An ankle sprain can lead to an over-stretched ligament that can cause bleeding in the “pulled-open” spaces of the tissue, it can cause a partial tear of the ligament and can cause the ligament to be pulled off of its bony attachment and/or a complete tear of the ligament.

Since there are numerous ligaments supporting the ankle on both sides there can be multiple ligaments involved in the injury. The mistaken notion that if it’s not broken, it does not require treatment could not be further from the truth.

Ligaments have no direct blood flow from an artery. They receive oxygen and nutrients from microscopic circulation. So blood flow to ligaments is somewhat restricted. Since the healing of all injuries depends on good blood circulation, ligaments are at a disadvantage due to their poor blood supply.

Most important would be compression and immobilization. Using an Ace bandage may limit some swelling, but it does not immobilize the ankle. Movement and the stress of weight-bearing on these tissues makes it that much more difficult for the ligament to heal.

Remember, any type of ankle pain is never normal. A foot and ankle doctor can examine your ankle and give you the best course of action.

Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.

Why Foot And Ankle Injuries Often Happen During Winter

Many people plan to “get more exercise” during the new year, but they need to be careful as Winter is a keen time for foot and ankle injuries.

If people are running or walking on new terrain, they may leave themselves open for a foot and ankle injury.

(image by health.nytimes.com)

Because of the icy or snowy roads, people may change their foot and gait patterns. This can lead to muscle strains, tendon injuries and more.

The front of the ankle is an area that can really take a beating when people move their exercise routine indoors.  This is especially true if you’re at the gym and doing doing one motion on an elliptical machine or treadmill.

Even if you change your pace a little bit and/or put your incline up higher, then you are straining the front muscles of your ankle that go across your ankle.

While people may think the greatest danger is running out on icy roads, indoor running tracks have their own risks. When people run consistently in one direction, usually counter clockwise, that can lead to injuries to knees or the Achilles tendon.

It’s a good idea if you can switch to every other day when you run on a track- and run laps in the opposite direction. Also, slow your pace when you take the curves, and save your higher speeds for the straight-aways.

If you are running on potentially slick terrain outdoors, get a pair of those spikes for the bottom of your shoes. Yak Tracks makes them and you put them on the bottom of your shoes and they help you with some traction when you are running.

If you are injured,  remember this: the word “RICE.”

Rest- get off your foot/ankle.

Ice- place an ice pack on the injured area for 5-10 minutes- unless specified by a doctor as someone with diabetes or vascular disease.

Compress the area- lightly wrap it with an Ace bandage- not too tight.

Elevation- reduce swelling and pain, elevate the foot or ankle higher than your waist.

The  key thing is to listen to your body. If it hurts, other than normal muscle pain, stop doing it. If the pain is persistent, long after your activity has stopped, then you need to see a foot and ankle doctor.

Remember, any type of foot pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action.

Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.

How to Choose a Foot and Ankle Doctor

How do you choose a good foot and ankle doctor? You want to look for someone who has the necessary education, certifications, residencies and experience.

If this all sounds complicated, we are going to break it down for you simply.

After completing an undergraduate degree (Bachelors Degree), a foot and ankle doctor should complete four-years of classes  at an accredited podiatric medical school and graduate with the degree of Doctor of Podiatric Medicine (DPM). Podiatric medical school classes also provide intensive focus on conditions of the foot and ankle.

After graduation from podiatric medical school, the foot and ankle doctor enters a post-graduate residency in podiatric medicine and surgery approved by the Council on Podiatric Medical Education. These residencies provide training in general medicine, general surgery, and surgical specialties. Currently, the majority of podiatric residency programs are three years in length.

After completing their residencies, foot and ankle doctors may receive additional training in specific areas of foot and ankle surgery through fellowships.

If your foot and ankle doctor is a board Certified foot and ankle surgeon, then that means he or she completed an intensive process leading to certification by the American Board of Podiatric Surgery (ABPS) includes four years of post-doctoral clinical experience, completion of an approved residency, a large number of surgeries representing a diverse range of foot and ankle surgical procedures, successful completion of an extensive two-part certification process and submitting surgical case logs.

Foot and ankle surgeons who have achieved certification by ABPS are eligible to become Fellows of the American College of Foot and Ankle Surgeons (ACFAS). This medical society provides continuing medical education programming to doctors and educates patients and consumers about foot health and the conditions.

Foot and ankle doctors provide  medical and surgical care for a wide spectrum of foot and ankle conditions for people of all ages.  Foot and ankle doctors are uniquely qualified to detect the early stages of diseases that exhibit warning signs in the feet, such as diabetes, arthritis and cardiovascular disease. They also manage foot conditions which may pose an ongoing threat to a patient’s overall health.

If you are suffering any type of foot or ankle injury, you should consult with a foot and ankle specialist who can provide you with the best course of treatment.

Remember, any type of foot pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action.

Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.

Anthony Kiedis Injures His Right Foot

The lead singer of the Red Hot Chili Peppers Anthony Kiedis arrived at the Staples Center in Los Angeles on January 8th, 2012, with an injured or broken right foot.

He was on crutches with his right foot braced in a walking boot.

His girlfriend, Beth Jeans Houghton also attended the Lakers vs Memphis Grizzlies game with Kiedis.

Kiedis has had ongoing problems with the metatarsals of his feet since the Stadium Arcadium Tour.

(images by stadium-arcadium.com)

Back in August of 2011, Kiedis spoke of his foot injury and how it originally occured: “I stayed out on tour with broken bones in my feet from jumping off the bass drum, which is kind of agonizing, and it led to me being in a bad state of mind.”

Kiedis was showing signs of a problem when photographed by Clara Balzary (below) with tape on his right foot, resting on his back while on tour in Vienna, Austria on December 7th, 2011.

There are 26 bones in your foot. These bones support your weight and help you to walk and run. Certain activities (such as jumping off a bass drum) can cause a fracture, or “break,” in one or more of these bones. Pain, swelling, redness, and even bruising are signs of a possible fracture.

Fractures of the foot can be diagnosed by x-rays or other studies. A foot and ankle surgeon can determine the best treatment course. Often rest, icing, and immobilization are the treatments; however surgery is sometimes necessary to repair the foot fracture.

Sometimes however, people mistake an ankle fracture for an ankle sprain. An ankle fracture involves a crack or break in the bones that form the ankle joint. A sprain involves the ligaments that hold the ankle bones together. Both injuries can happen simultaneously, but a fracture requires more complex medical care than a sprain.

There are no good walking tests to determine if an injury is a sprain or a fracture because walking is still possible with less-severe injuries. Telltale signs of a fracture include bruising, blisters, significant swelling, or bone protruding through the skin. In addition to bone, ankle fractures can also involve cartilage surrounding bones.

It’s not clear if Kiedis mistook his broken bones for a sprain or not, but clearly he was aware that he was suffering some sort of foot injury while on tour. Why he did not seek medical care immediately is a mystery (unless maybe he was concerned about ending the tour early).

If you are suffering any type of foot or ankle injury, you should consult with a foot and ankle specialist who can provide you with the best course of treatment.

Remember, any type of foot pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action. Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.

Ankle Fusion or Ankle Replacement Surgery?

Every year in the U.S. about two million people visit their foot and ankle doctor for ankle pain from arthritis or fracture.

About 50,000 have end-stage ankle arthritis, in which the ankle cartilage has worn away completely, causing bone-on-bone contact.

For years these people have had only one surgical option: ankle fusion surgery, which is when the worn-out part of the joint is removed and the bones are permanently locked together with screws and plates.

(image by care2.com)

While ankle fusion surgery often relieves pain, the patient loses mobility in the ankle, leading to changes in their walk and adding additional wear and tear to other parts of the ankle. A new option to ankle fusion surgery is ankle replacement surgery.

Amazingly, many patients don’t even know that ankle replacement surgery exists.

The ideal ankle replacement surgery patient is around 60 years old and of normal weight, although foot and ankle doctors will consider older patients, depending on their health.

People with diabetes may not be good candidates because they may risk problems  as a result of poor blood circulation. But for those who are eligible for ankle replacement surgery, the results can be amazing, thanks to the implant that basically replaces the damaged bone.

The new models of implants require that less bone be removed, so the bone to which the device is affixed is stronger. Also, technology used to guide foot surgeons in aligning the artificial joint has improved.  Recent data has shown that 90 percent of ankle replacements were still in place after an average of eight and a half years.

Though the four devices in common use have technical differences in design and in how they are implanted, foot and ankle doctors say the choice of implant matters far less than the experience of the foot and ankle surgeon. The procedure is among the most difficult that foot and ankle surgeons perform, and one of the biggest challenges is getting proper alignment of the replacement joint.

With a successful implantation, patients can expect very good results, but at the same time seniors citizens should not expect to have the same ankles they did at 18. While they won’t be dping long distance running, they can golf and walk, and sometimes even ski. Or more importantly, they may be able to go to their grandchild’s wedding and get up and have a dance.

So should you have ankle fusion or ankle replacement surgery? You should consult with a foot and ankle surgeon who can provide you with the best course of treatment.

Remember, any type of foot pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action. Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.

What You Need to Know About Ankle Replacement Surgery

If you or someone you love is considering ankle replacement surgery, you may a few questions about the procedure.

If that’s the case, then here is what you need to know about ankle replacement surgery.

(image by orthopedicsurgerybook.com)

The average age for ankle replacement surgery is not much different than replacement of the hip or knee, around 60 years of age. In some cases the age is much lower, especially in rheumatoid arthritis where age is really not a factor.

The type of implant used in ankle replacement surgery is critical to the long-term success. There are many different types of joint implants available around the world today. Your foot and ankle surgeon should be able to discuss these issues with you and provide you with an explanation of which implants he or she uses and why.

Before you have ankle replacement surgery, there are general medical tests carried out. These frequently includes lab work, chest x-ray, EKG, and so forth, and additional tests to evaluate circulation and nerve function. CAT scans or an MRI may be necessary to find out the quality of the bone around the ankle joint, as well as the joint under the ankle and in the mid-foot.

The usual hospital stay following ankle replacement surgery is two nights. Frequently, patients have gotten out of bed the day of surgery and are allowed to go to the bathroom if they are stable and have the ability to use crutches.

Range of motion or movement of the ankle is started on the second day and continued with no weight bearing for six weeks. At six weeks, an x-ray is taken of the ankle.  In individuals with very soft bone, if their body weight would put extreme pressure on the ankle, occasionally weight bearing is delayed or at least slowed to allow the bone strength to improve.

By three months after ankle replacement surgery, most patients are walking without crutches and usually have no pain, although some aching in the joint will persist until the bone is strong enough to support the body’s weight. This can take six to nine months after the ankle replacement surgery and, in some instances, can be associated with swelling.

It is recommended that patients consult with a foot and ankle surgeon who can provide them with the best course of treatment for their ankle replacement surgery.

Remember, any type of foot pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action. Please call 626-447-2184 (Arcadia) or 310-551-1711 (Century City) to speak to a foot and ankle specialist about your foot and/or ankle needs.