Podiatry

PODIATRIC MEDICINE


THE RIGHT PODIATRIST FOR YOU

The human foot has a complex interrelation with the rest of the body, which means that it may be the first area to show signs of serious conditions such as diabetes and cardiovascular disease.



EXPERIENCE PODIATRY SURGERY DONE RIGHT

Allow our podiatrist to assess the right surgery for your condition. Our podiatrist is board certified and specializes in surgical treatments. Learn more about Dr. Lear-Rayborn… We look forward to speaking with you!


Learn more about Podiatry…

  • Which Podiatry/treatment services do you provide?
  • What is a Bunion?
  • Diabetic Foot Care
  • What causes Gout?
  • Patient Education on Hallux Limitus
  • Do you have hammertoes?
  • Foot and ankle care: Tips & Tricks
Which Podiatry/treatment services do you provide?

As a Podiatric physician our care is centered on treating all conditions pertaining to the foot and ankle. Some of the more common things we treat are listed below:

Achilles Tendon Disorders
Ankle Instability
Ankle Sprains
Arthritic Foot & Ankle Care
Athletes Foot
Ball of Foot Pain (Capsulitis)
Bone Spurs
Braces
Bunions
Calluses
Casting
Clubfoot
Comprehensive Care of Foot & Ankle Disorders
Corns
Crush Injuries
Custom Made Orthotics
Diabetic Foot Ulcers and Charcot
Flat Feet
Fracture Care
Fungal Nails
Gait Evaluation
Geriatric Foot Care
Gout
Hammertoes
Heel Spurs
Ingrown Toenails
Injuries
Lower Extremity Vascular/Neurologic Evaluation
Neuromas
On Site X-Rays
Pediatric Foot & Ankle Care
Permanent Removal of Ingrown Toenails
Plantar Fasciitis/Heel pain
Plantar Warts
Preventive Foot Care
Second Opinions
Splinting
Sports Injury Management of the Lower Leg, Ankle & Foot
Supports
Wound Care
What is a Bunion?

What is a bunion?
A bunion is a bump on the big toe side of the foot and is actually bone. It may be red and painful whether you are walking or resting. The first metatarsal, the large bone located where the toe meets the foot, rotates outward and pushes your big toe inward toward your other toes. This can sometimes cause your toes to overlap, which causes pain.

What causes bunions?
Bunion formation runs in families, so if a parent or other relative has a bunion, you have a higher risk of also developing a bunion. Bunions can be irritated by friction from ill-fitting shoes. Wearing high-heeled shoes puts unwanted pressure on the joints of the forefoot, which can result in painful bunions. Bunions may be caused by a congenital anatomical deformity, flat feet, a tight Achilles tendon, polio, or rheumatoid arthritis. Even if you develop a bunion, it may not progress to the point where it needs surgical correction. Nonsymptomatic bunions can be managed by appropriate shoe wear.

When choosing shoes, follow these tips:

  • Judge the shoe by how it fits and feels on your foot, not by the size marked on the shoe or the box.
  • Measure your feet regularly as you grow older. Foot size changes with age.
  • Try on shoes late in the day when your feet are at their largest.
  • Do not wear shoes that feel too tight. Do not expect them to stretch.
  • Make sure your heel fits comfortably in the shoe with minimum slippage.
  • Walk around in the shoe to make sure it fits well.

Diagnosing bunions
Diagnosis of bunions is based on physical examination, a complete history of your symptoms, and diagnostic studies. Diagnostic studies help the podiatrist determine the precise nature of the deformity. He or she can determine the extent of the problem with the big toe and how much the second toe is involved. Your podiatrist will assess your standing and walking to determine whether or not your gait is affected. Your range of motion will be tested as well, and a vascular and neurologic assessment will also be made prior to treatment.

Conservative treatment of bunions
Before surgical correction of bunions is undertaken, the podiatrist may treat your bunion with conservative measures.

Conservative treatment modalities include:

    • Activity modification, rest and elevation of the affected foot;
    • Changing to footwear that puts less pressure on the tender area;
    • Soaking the foot in warm water;
    • Anti-inflammatory medications;
    • Steroid injection into the area surrounding the affected joint;
    • Orthotic devices;
    • Using cushioned padding in the shoes;
    • Taping the foot to retain normal positioning;
    • Physical therapy, including ultrasound therapy or whirlpool baths.

Surgical correction of bunions
If nonsurgical treatment is not successful, your podiatrist may suggest surgery. Studies show that 85-90% of patients who have bunion surgery are satisfied with the results. The goal of bunion surgery is not to improve the cosmetic look of your foot. The goal of such surgery is to relieve your pain and correct your foot deformity.

If your bunion causes foot pain that restricts your everyday activities, you may benefit from bunion surgery. Other indications for surgical correction include chronic inflammation that does not improve with rest or medication.

Preparation for surgery
If you decide to have bunion surgery, your podiatrist or your personal physician will assess your general health. You may need preoperative clearance from your primary care or treating physician. Conditions such as diabetes, rheumatoid arthritis, or circulatory difficulties could negatively impact your healing and could increase postoperative pain.

Be sure to tell your podiatrist what medications you take regularly, including herbal or natural remedies. Follow your podiatrist’s instructions on which medications you should or should not stop taking before surgery.

You may or may not be required to have blood tests, cardiac testing, chest X-ray, or urinalysis in addition to foot X-rays or other imaging studies.

The usual surgical outcome
Most patients have a significant decrease in pain after surgery and greatly improved alignment of the big toe. Your outcome will depend on how severe your bunion deformity was before surgery, your medical condition, your age, and your compliance with postoperative instructions. In general, there may be some degree of swelling of the foot for three to six months following surgery.

Your podiatrist will follow you closely during this postoperative period and recommend exercises or physical therapy to improve foot strength and range of motion. Depending on the extent of your condition, you can expect a recovery period of at least six to eight weeks, or longer. During that time you may be required to wear a special shoe or boot, or even a cast to provide stability to the foot. Your doctor will tell you when you can walk on your foot again.

Risks of bunion surgery and potential complications
Even the most minor surgical procedure has a degree of risk. Your podiatrist will go over the most common problems that have occurred after bunion surgery. These include infection, recurrence of pain, nerve damage (which could be chronic), recurrence of the bunion, poor healing, bleeding, scarring, blood clots, or allergic reaction. Most complications are treatable, but may increase your recovery time. Although it is rare, you could experience stroke, heart attack, loss of a limb, or death.

Your podiatrist will go over all these possibilities with you so you have a full picture of what to expect. After he or she has described these potential risks to you, you will be asked to sign a form called an informed consent form. Be sure to ask questions if you are uncertain about what you are being told, and make sure your questions are answered to your satisfaction. Your signature on this form indicates that your questions have been answered and you have been informed of the risks and potential complications of bunion surgery.

Types of bunion surgery
Your podiatrist will determine which type of surgical procedure is right for you. There are many different types of surgical procedures for treating bunions, many of which are named after the doctors who developed them. Examples of these are Keller bunionectomy, McBride technique, and Austin osteotomy. Ask your doctor to explain the type of procedure he or she feels is best for you.

Many bunion surgical procedures are done as outpatients. You will be asked to arrive at the outpatient facility one to two hours before the surgery, and can usually go home an hour or two after the surgery. The procedure itself will take about one hour.

The type of anesthesia used will depend on the type of surgery done, your condition, and the anticipated length of the surgery. Most bunionectomies are done with a local anesthetic agent to numb the area. In some cases you may have general anesthesia. After surgery you will go to the recovery room. You will have one or more scars after the surgery, depending on the type of surgery performed.

Postoperative recovery
It is important that you follow your podiatrist’s instructions completely following the surgery. You will be following up with visits to your podiatrist regularly for several months after your surgery.

You should call the office immediately if you notice any of the following:

    • Fever of 101oF or higher and/or chills;
    • Persistent, uncomfortable warmth or redness around the dressing;
    • Persistent or unbearable pain;
    • Bloody drainage;
    • Nausea and/or vomiting;
    • Pain, redness, or swelling in one or both legs;
    • Feeling anxious;
    • Chest pain, shortness of breath, or coughing.

You will be sent home after surgery with a dressing to hold your toe in the realigned position. You may or may not receive a special surgical shoe to wear for some time. You should notify your podiatrist if your dressing comes off or gets wet, or if you notice blood or other drainage on it. It is very important to leave the dressings in place and not get them wet or dirty. If you have difficulty with your dressings, call your podiatrist.

Postoperative office visits
Ordinarily you will see your podiatrist three or four days after surgery for a dressing change, and postoperative X-rays may be taken at that time. About two weeks after surgery your podiatrist will remove the stitches. Once the stitches are removed, you may be able to bathe normally. Be sure to ask your doctor for instructions.

Your doctor will let you know when you can start to wear shoes, and the best type for you. You should continue to faithfully do the exercises your podiatrist has given you. Apply skin emollients, such as aloe vera or vitamin E, around the healing wound as directed. Your doctor will instruct you on when you can walk, drive, and resume other activities.

The postoperative course varies for individuals. For some patients, swelling may last longer and healing may take more time than anticipated. You should try to keep your foot elevated as much as possible immediately after the surgery. Your doctor may instruct you to apply ice to your foot. If so, ask him or her to provide you with specific instructions on how to do this. You could experience some swelling in your foot for several months following the surgery. Contact your doctor if you have questions about your swelling.

Exercise
Be sure to engage in the exercises your podiatrist recommends. These exercises will help restore your range of motion and your foot strength. Do not engage in any strenuous or weight bearing exercises that are not recommended by your podiatrist.

Diabetic Foot Care

DAILY FOOT CARE

    • Wash, DO NOT SOAK, your feet in luke warm water.   Use a mild soap and test the water temperature with your wrist to prevent burning of your feet.
    • Dry feet well, especially between toes.

DAILY EXAMINATION OF FEET

    • Examine your feet closely, if you cannot see the bottom of your feet, use a hand mirror placed on the floor. If your eyesight is poor, have someone check them for you.

DAILY SKIN CARE OF THE FEET

    • Lubricate your feet to prevent dryness using a moisture lotion. Feel for any sore, rough or tender areas. Avoid putting lotion between toes.
    • If dryness continues even though using dry skin cream, have your feet checked and contact us for an appointment.

CARE OF TOENAILS AND CALLUSES

    • NEVER use scissors or an instrument to cut your nails.
    • NEVER cut out or dig into nail corners.
    • Allow Dr. Lear-Rayborn to trim your nails regularly.
    • After washing feet, pat the corns and calluses dry and rub a moisture lotion into them.
    • NEVER tear off loose skin.
    • NEVER use corn or callus remover products, these contain acids that can burn your skin and may cause a sore.
    • NEVER cut corns or calluses. Allow Dr. Lear-Rayborn to trim them.

FOOTWEAR

    • NEVER go barefoot.
    • Shoes should fit properly allowing room for all toes to be in their natural position. Break in shoes gradually to avoid blisters.
    • Avoid tight fitting and pointed shoes.

ATHLETE’S FEET

    • Athlete’s Foot is caused by a fungus which likes warm, dark and moist areas.
    • Always notify the office of any itching, blistering or scaling occurring between the toes or on any part of the foot.

EXERCISE

    • Walking is your best exercise for the feet, but one must always have shoes that fit properly.
    • DO NOT SMOKE.

Always remember to check with Dr. Lear-Rayborn if you have any questions or problems occurring with your feet. I will always be available to answer any questions you might have regarding foot care.

What causes Gout?

Gout is a form of arthritis that occurs most typically within the big toe joint, however attacks can occur in other areas also.

SYMPTOMS
The disease produces pain, swelling, redness and warmth in the big toe joint. There is usually a sudden onset of pain and symptoms. Many patients the pain awakens them from sleep.

CAUSES
Most often it occurs in men and in post-menopausal women. It occurs as a result of having too much uric acid in the body and in the joint fluid due to the accumulation of purines found in protein substances found in the diet. Uric acid is sensitive to temperature changes and at cooler temperatures it turns into crystals. Because your big toe is farthest from your heart, it is also the coolest part of the body and is more susceptible to developing gout. Organ meats, beer and salt should be avoided. Also, gout may be precipitated by an operation, emotional stress and diuretic intake.

TREATMENT
Oral anti-inflammatory drugs, immobilization, elevation and steroid injections are all first line treatments for acute attacks. Long term control of uric acid levels can be done with medications also.

Patient Education on Hallux Limitus

Hallux limitus is a type of degenerative arthritis of the first metatarsophalangeal joint or the big toe joint. It is a progressive deformity and when all motion is lost, it them becomes hallux rigidus.

Symptoms
Pain, swelling and stiffness in the big toe joint with range of motion. The pain can lead to problems with certain types of shoes and activities.

Causes
In most cases, the cause of hallux limitus is due to the mechanics of the foot. Patients with flatfeet, may develop this condition. Other causes of hallux limitus include overuse, post-traumatic and inflammatory joint diseases, such as rheumatoid arthritis or gout.

Treatment
Non-surgical management of hallux limitus may include modification of shoes, orthotics, anti-inflammatory medications, and cortisone injections into the joint. If these treatments do not effectively eliminate the symptoms, surgical options are also available. The type of surgical procedure performed depends on multiple factors including the severity of the condition, patient age, and activity level of the patient. Sometimes, this entails just removal of bone spurs and other times may require fusion of the joint.

Do you have hammertoes?

A hammertoe is a contracture of the toe caused by a tendon imbalance in your foot. It develops a prominent area on top of the digit and can lead to pain with pressure and wearing shoes.

Symptoms
There may be redness, pain, and the development of a corn/callus on. Also, a callous can form on the bottom of the foot due to retrograde pressure from the hammered digit.

Causes
Hammertoes are caused by tendon imbalances and can also be inherited.

Treatment
Non-surgical treatment for hammertoes includes: trimming of corns and calluses by your doctor, padding, changes in shoe wear, and splinting of the toe. Surgical correction may include the removal of a small piece of bone from the joint or a fusion of the joint to straighten the toe. These procedures may include utilizing a pin to hold the toe straight during the healing process.

Foot and ankle care: Tips & Tricks

Stretching is a very important preventative and therapeutic modality. The following stretching exercises will help you strengthen you calf muscles and may eliminate the risk of any associated secondary problems, like heel pain.

1. Step Stretch step_stretch
Stand and face the stairs with both feet firmly planted on the last step and hold the handrails. Place the ball of one foot at the end of the step and push your heel downward until you feel a nice stretch in your calf. Hold for 10 seconds; then relax and switch to the opposite leg. Repeat this exercise 10 times for each side, 3 times a day.

wall_stretch

2. Wall Stretch
Stand at arm’s length from the wall with your back knee locked and your front knee bent. Slowly press forward by bending your arms until a moderate stretch is felt in the calf muscle of your straight leg. Keep both heels on the floor. Hold for 10 seconds. Switch legs and repeat. Repeat this exercise 10 times for each side, 3 times a day.

towel_stretch

3. Towel Stretch
Roll a medium size towel lengthwise tightly. Place it around the ball of your foot with your knee straight. Pull the towel with both of your arms using even pressure until a moderate stretch is felt in the back of the calf muscle. Do 10 repetitions with your knee straight, then 10 with your knee bent, alternating legs, 3 times a day.

bottle_stretch

4. Bottle Stretch
Sit in a chair. Place a can or water bottle on the floor. Roll your foot slowly with even pressure from your heel to the ball of your foot, back and forth. Roll 20 times for each foot, 3 times a day.


More information

DOWNLOAD


CARE BROCHUREPODIATRISTBOOK A VISIT

Copyright by Alyeska Vascular Surgery 2018. All rights reserved.