The Weil Foot and Ankle Institute’s Comprehensive Guide to Summertime Foot Care!

By: Williette Nyanue - According to the almanac, the official start of summer this year will not be until June 20^th. However, with the celebration of Memorial Day this past weekend, many of us are already fully immersed in the summer season.

Because each season brings with it its own set of challenges for our bodies, many of us change our health routines to reflect the change in season. In the fall and winter months the temperature drops and the air gets drier leaving us with dry skin, hair and nails. To combat this drop in temperature and humidity, many of us switch to heavier creams and maybe even shorter, cooler showers. The winter months also have their own uniform: sweaters, thermal underwear and boots to combat the snow. When the summer season starts, this winter routine is almost completely reversed. With longer days, and therefore longer exposure to sun, and higher temperatures, we use lighter creams with a higher SPF, and drink more water to prevent dehydration. As for the summer attire, well, we all know that there is more skin, more skin, and then more skin.

As we change our health routines to adapt to the changing weather, we must not forget that our foot care routines will also require some slight changes. The summer months bring specific problems for our feet that you may not be aware of. Just as you would switch your skincare regimen and wardrobe for the summer, be sure to switch your foot care regimen…or at least implement one if you haven’t already!

So you don’t know where to start? Have no fear! I contacted Dr. Weil, Jr. and he has given me some great information in order to help me create a comprehensive guide for your summer foot care needs. Follow the points on this guide and you’ll be sure to keep your feet healthy throughout these summer months.

Temperature and Sun Exposure

The elevated temperatures of the summer months bring a unique set of challenges for your feet including increased sweating, which can lead to odor and fungal and bacterial infections, and exposure to the sun's harmful rays. Here are a few ways to adjust your routine to combat these issues.

Elevated temperatures

• Invest in a foot antiperspirant/deodorant if you suffer from foot odor or sweating. 
• Make sure that whatever shoes you are wearing allow your foot to breathe. For all of the runners and athletes out there, this is really important if you must wear closed to shoes during the warmer months. See a few options for athletic shoes here and here. 
• Wear lightweight socks when you wear closed toe shoes, and change them regularly. We offer a sock on our website that you may want to check out. It efficiently transfers heat and eliminates bacteria, fungi and odor.
•  If you develop excessive sweating, foot odor or any fungal/bacterial infections, be sure to contact one of the physicians at the Weil Foot & Ankle Institute for an evaluation.

Sun Exposure

• Don’t forget to put sunscreen on your feet! You can use the same sunscreen that you use for your body. Remember that feet burn easily because they are not regularly exposed to sun, so don’t increase the risk by neglecting them with sunscreen. 

What to wear, what to wear?

Just like we need to change our wardrobes for the warmer months, it is important that we make the proper changes to our footwear. Here are some things to consider when buying shoes in the summer.

•  Invest in the footwear of the season: open toe sandals. Open toe sandals, allow our feet to breathe and stay dry. This prevents sweating, odor and bacterial growth.
• Make sure that your sandals provide good arch support. They should not be flat. Higher heels are better.
• Invest in sandals with a stiffer sole, which offer more support for you than flexible soles.
•  Make sure the sandals provide comfort. Do not sacrifice comfort for style because you will regret it in the long run. Believe it or not, there are fashionable sandals that also provide comfort.

To flip-flop or not to flip-flop?

The ease and convenience of flip-flops make them the summer shoe of choice for many of us. Flip-flops, however, lack arch and heel support. The gripping that your toes have to do when walking in flip-flops also puts tension and strain on your shins. When buying and wearing flip-flops:

• Do not wear flip-flops when engaging in strenuous activity such as running, walking for long distances, playing sports, etc.
•  Make sure that your flip-flops are made with a flexible but firm material to prevent foot injuries that may come from excessive bending.
• Make sure that your flip-flops offer good arch and heel support. A great option for a flip-flop would be our Orthaheel sandals. They are cute and supportive and were recommended by Dr. Oz on a recent video segment from his show.

Going barefoot?

Summer is the time when you’re most likely going to be barefoot. Who doesn’t like to feel the grass beneath their feet or the sand between their toes? If you do not have pain, going barefoot is ok, but keep in mind there are many problems associated with barefootedness including heel pain and metatarsalgia. When walking barefoot:

• Beware of foreign bodies and things that can injure the skin including glass, branches, cans, rocks, etc.  
• Limit exposure to moist surfaces that are shared by multiple people. This includes pool decks, locker rooms, etc. This will limit the chances of fungal infections and warts.
•  Be careful of hot sand, which can burn feet. This is especially true for diabetics who don't have good feeling in their lower extremities. 

Prepare yourself for activity

Common foot and ankle injuries due to increased activity in the summer include shin splints, ankle sprains, tendinitis, blisters and bruises, stress fractures of the toes or ankle, and plantar fasciitis. Make sure to take a few simple precautions to prevent these injuries.

• Build up activity progressively. In other words, don't sit all winter and go out and try to run a 5K without training properly and building up your muscles.
• Make sure you stretch properly before and after training.
•  Invest in good athletic shoes and make sure to change them frequently. Athletic shoes that are in good shape will have less than 400 miles of wear.
•  Invest in insoles to properly support your feet and ankles while engaging in athletic activity. We offer insoles on our site, and we also make them custom in our office. If you would like a set of our custom made orthotics, be sure to request an appointment for a consultation today!

If you develop any of the problems mentioned in this post, (foot odor, warts, fungal infection, heel pain, metatarsalgia, plantar fasciitis, etc.) make sure that you call and/or visit the Weil Foot & Ankle Institute so that one of our physicians can get you healed and have you back out enjoying the summer weather as quickly as possible. Now that you have a basic set of guidelines for ensuring your foot health this summer, go out and take advantage of the warm weather. It will be winter again before you know it!

Did we miss anything? Do you have a foot problem relating to summer that you did not see addressed here? Tell us below and we will be happy to provide you with suggestions and solutions!

Common Foot Problems in Pediatric Patients

By: Erin Klein, DPM

I have had the pleasure to treat many children here at the Weil Foot and Ankle Institute and have found that the problems pediatric patients face can be very different than those of adults. Much like children’s shoes, pediatric foot problems come in all shapes and sizes. The physician that treats children’s foot problems needs to be attuned to the way children communicate, as well as the special needs of our littlest patients.

The six common problems we see in our pediatric patients here at the Weil Foot and Ankle Institute are: flatfeet, intoeing, gait problems, heel pain, infected ingrown toenails and warts. I have provided an overview of each condition, as well as treatments that we use to solve these common pediatric foot problems.

Infected, ingrown toenails:

An ingrown toenail is a toenail that has curved in at the medial and lateral sides of the nail. It digs into and can cause a break in the skin. Bacterial infections of the ingrown toenail are a potentially serious condition that requires medical attention. When children with infected, ingrown toenails come to see me, many have already seen at least one other medical professional and may have already been placed on antibiotics that really didn’t help. Infected, ingrown toenails are one of my favorite problems to treat in pediatric patients because with a small procedure done in the office, children can be back on their feet rather quickly.

In order to do this small, in-office procedure, we inject the toe with local anesthetic. Pediatric patients, young and old, may yell, scream and carry on while we perform the injection. I’ve seen that this can be a bit embarrassing to parents – but – I don’t blame the kids for screaming. If you stuck a needle in my toe, I’d have to scream too! The reason we do this is not to torture kids, but to rid the cause of the bacterial infection (the ingrown nail) and irrigate the area. This will help the infection to clear and have the child pain and infection free in little to no time.

Flatfeet, intoeing and gait problems:

I see pediatric patients with complaints of flatfeet and gait problems everyday. Sometimes, this is a medical problem that needs to be treated, other times – not so much. It is perfectly normal for children to have flatfeet or walk slightly intoed. Many times this is painless and will resolve (somewhat) with age. There is no evidence in medical literature to suggest that flatfeet or a slightly intoed gait will prevent a child from being able to walk, run or live a full and healthy life.

Flatfeet and intoeing become problematic when they cause children to have pain in their feet, feel that their legs tire easily with activities such as walking, running or playing with their friends, or have excessive wearing on the soles of their shoes. Children that refuse to walk or “don’t wanna” walk may be experiencing pain in their feet or legs, and just don’t know how to communicate that to their parents. If you would like to find out whether or not your child’s flatfeet, intoeing or gait problem is problematic to his/her overall foot health, be sure to contact one of our Weil Foot and Ankle physicians to schedule an evaluation.

Heel pain:

Pediatric heel pain is not a condition to take lightly. Although children rarely experience heel pain in the same way adults do, it is still important to have the area examined and properly diagnosed.  Please contact your Weil Foot and Ankle physician immediately if your child is experiencing heel pain, as this may be a serious condition that requires treatment. Most of the time, pediatric heel pain is related to inflammation of the growth plate in the heel bone. This is easily treated with rest, ice and stretching. There is the possibility, however, of a more serious condition in which pediatric heel pain is caused by an infection in the bone.

Warts:

Warts are tricky and can be very frustrating to treat in pediatric patients. Warts are a dermatological manifestation of a virus that can be acquired at the pool or beach in the summertime, or on any wet, damp surface that is used by multiple people (i.e. locker rooms). Warts can be extremely painful as they are often located at pressure points in the foot and have their own blood and nerve supply. There are many options for treatment of this problem – the most important part of treatment being, keeping the area of the wart dry. Why? Warts prefer warm, moist environments. If you remove the moisture (sometimes it is hard to remove the elevated temperature), the warts will not grow as readily and the body can start to help remove them from the area.  We have some wart removal products (Pedinol and Plantarstat) available in our online store that may assist in drying and ultimately removing the wart.

Challenges unique to treating children.

Treating children is quite fun, however, it can also be extremely challenging. Kids don’t think, feel or communicate the way adults do. They get scared that they won’t be able to walk again, they won’t be able to play with their friends again or, most commonly, that “it’s gonna hurt.” Kids also get worried that I, as a physician, won’t believe that they are in pain. They fear that if they admit that they are in pain or hurting, their parents will feel bad – and kids don’t want that.

My personal approach is to listen. Kids can communicate – in their own, uniquely kid way – and, if you listen, you will hear. I also enjoy playing with some of my youngest patients (pretty much anyone under the age of 3). This way they don’t realize that I am examining them and learning about their problems, and they don’t have to sit in the scary grown-up examination chair.

The best part about treating kids is their unique ability to brighten just about any day. I mean, how can you be that big of a grump when a 4-year-old hands you a hand-drawn picture of a dinosaur, or when a 6-year-old colors you a picture of a goofy looking doctor, or when one of your teenagers makes you a duct tape stethoscope and medical bag just for fun, or when a 2-year-old decides that you need a hug? You can’t be grumpy after that! J

Erin’s Top 10 Things She Loves about Treating Kids:

1. They say thank you.
2. They WANT to get better
3. They can be so cute!
4. They do goofy things like draw you pictures and make you duct-tape stethoscopes – and this really makes my day.
5. They speak simply, in terms that actually make sense to me.
6. They smile, giggle and make funny faces.
7. They give good hugs – especially kids in the 2-year-old age range.
8. They are amused by the simplest things – like head, shoulders, knees and toes…. which little piggy went where…. playing ball in the hallway…(They have no idea that I’m examining them while I’m doing all of this either!)
9. Lollipops and suckers can cure anything.
10. I think I might just be a little kid in a grown up’s body!

Treatment for Plantar Fasciitis: ESWT

C.J. Watson's plantar fasciitis surgery at the Weil Foot and Ankle Institute was all over the news, blogs and Twitter last week. Many fans did not know that C.J. Watson struggled with plantar fasciitis, and others did know that it bothered him so much that he needed surgery! As noted in Dr. Weil, Jr.'s blog post on plantar fasciitis, patients have several treatment options. While patients can utilize conservative treatment to alleviate symptoms, if pain persists, patients can opt for either non-invasive and/or minimally invasive treatments for plantar fasciitis, both of which have been pioneered by Weil Foot & Ankle Institute physicians.

The non-invasive procedure that Weil Foot and Ankle Institute physicians employ is called Extracorporeal Shockwave Therapy more commonly know to us as ESWT. ESWT has been FDA Approved since 2000 and uses sound waves to stimulate healing in some physical disorders, such as plantar fasciitis and Achilles tendonitis. "Extracorporeal" means "outside of the body" and refers to the way the therapy is applied. Because there is no incision, ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity. 

There are two different types of ESWT that can be performed including:

Low Energy ESWT

Low energy ESWT is performed in three sessions over three weeks. Low energy ESWT sessions are performed in the clinic setting, take approximately 10 minutes and are generally done without anesthesia or sedation. Patients can return to normal work and life immediately after their treatment.

High Energy ESWT

High energy ESWT is performed in one session. Anesthesia/sedation is required for this procedure, which takes approximately 30 minutes. Someone will need to be present to drive you home afterwards.

The surgeons at Weil Foot & Ankle Institute can discuss the risks and benefits of each procedure with you so that.

If you would like to learn more about ESWT, and to find out if you are a candidate for treatment, visit here and call our office at 847-390-7666 to schedule your consultation now!

Diabetes and Manifestations in the Foot and Ankle

By: Zacharia Facaros

According to the American Diabetes Association, over 25 million people in the United States, roughly 8% of the population, have Diabetes, however, there are many more who are undiagnosed.  Diabetes can have a huge impact on the health of your feet and ankles. The Diabetes Association of America notes that 60-70% of people with diabetes develop peripheral nerve damage, and up to 29% of these patients may develop a specific type of fracture/dislocation in the foot or ankle, referred to as Charcot Neuroarthropathy.

Nerve damage, or neuropathy, is a well-known complication of diabetes, as well as other conditions, which leads to a loss of sensation in the feet. Patients with nerve damage can no longer feel when something has irritated or even punctured the skin. An irritation or puncture to the feet commonly creates a wound as small as a blister, but the wound can progress to a serious infection in a matter of days.

If you have diabetes, you need to be aware of how foot problems can arise and how to treat them.  Outlined below are important steps to take for close monitoring and management of your lower legs and feet:

CONTROL YOUR DIABETES

• ·         Work with your doctors to keep your blood sugar within a good range and to keep all other medical illnesses closely monitored.  The more stable your blood sugar remains, the less likely you are to succumb to neuropathy and/or infection.

INSPECT YOUR FEET DAILY

• Look at your bare feet every day to check for scratches, cuts, blisters, open wounds, red or warm spots and swelling.  If any are present, the risk of getting an infection is increased, and you should contact a Weil Foot and Ankle physician for an evaluation.
• Check the bottoms of your feet daily with a mirror. Checking the bottoms of your feet will reveal any potential at-risk areas that one may not appreciate if their sensation is not intact. If you have trouble bending your leg or seeing, ask a family member for help. 
• Contact a Weil Foot and Ankle physician immediately for evaluation if one foot is swollen or warmer than the other. This swelling or warmth may represent a potential urgent medical condition.

WASH YOUR FEET WELL DAILY, PARTICULARLY IN BETWEEN YOUR TOES

• Wash your feet daily in the shower or in lukewarm, not hot, water with mild bath soap. This provides a stable, clean, non-toxic maintenance.  Test the water temperature with your hand first to avoid a potential skin burn.
•  Do not soak your feet. Soaking your feet can weaken the skin, and this weakened skin will not maintain as strong a barrier against bacteria and/or fungus infections.   
• Dry your feet well, particularly in between the toes, to avoid a damp/moist environment that makes skin prone to infections.

KEEP YOUR SKIN SOFT AND SMOOTH

• Rub a thin layer of skin lotion over the tops and bottoms of your feet to prevent dry, cracked skin. Ask your Weil Foot and Ankle Physician for recommended products. Avoid putting lotion on the area between your toes. By avoiding this area, you will avoid making the skin susceptible to bacterial and/or fungal infections.
• Do not use strong antiseptic solutions, drugstore over the counter medications or heating pads.  Do not put your feet on or near radiators, nor to close to a fireplace or heating lamp. All of these actions may cause skin compromise and rapid drying of the skin.

NEVER TRIM OR SMOOTH CORNS AND CALLUSES YOURSELF OR CUT YOUR OWN TOENAILS IF IT IS DIFFICULT TO DO SO

• Following evaluation by your Weil Foot and Ankle physician, and if your feet are at low risk for problems, you may be allowed to use a pumice stone or emery board to smooth corns and calluses, but it is IMPERATIVE that you do not rub the skin too vigorously. Vigorous scrubbing may create an open wound.
• See a Weil Foot and Ankle physician right away if you have an ingrown toenail, especially if it has turned red, hot and swollen.  This condition requires expedited treatment for proper healing.
• Cut toenails straight across to limit the possibility of the corners becoming ingrown. Due to the high risk of causing a skin cut that may also lead to a potential infection, never dig into the corners of your nails. 

WEAR PROTECTIVE FOOTWEAR AT ALL TIMES

• Never go barefoot, or limit times when you do.  This will ensure proper protection of your skin or at-risk pressure points.
• Wear comfortable shoes that fit well and protect your feet. Walking or running shoes may be helpful for some diabetics, whereas others require specific therapeutic shoe gear. The Weil Foot and Ankle Institute has a great selection of shoes and can create custom shoes for diabetic patients. Be sure to ask your Weil Foot and Ankle physician about diabetic shoe options.
•  Purchase new shoes at the end of the day when your feet have natural swelling and are typically larger. Doing this will enhance a proper fit.  Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes because your foot will change shape over the years.
•  Wear new shoes for only 2 hours or less at a time, particularly if you have neuropathy. New shoes will cause increased pressure points until they are adequately broken in.
• Do not wear the same shoes everyday. Alternating the shoes that you wear will allow them to dry completely and to limit the quantity of potential infectious organisms. It will also allow your feet to maintain adaptation and functioning capacity.
• Feel the inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside, such as small pebbles or other foreign objects.
• Do not lace your shoes too tightly or loosely. Lacing your shoes comfortably will help to avoid increased friction or pressure points that may lead to blistering or even ulceration. 
• Choose socks and stockings carefully. Wear clean, dry socks every day and avoid socks with holes or wrinkles. Avoid stockings with elastic tops. Seamless socks are available for those with neuropathy, and therapeutic compression stockings are recommended if your feet and legs swell often.  In socks and stockings, certain materials are recommended over others, so check with a Weil Foot & Ankle physician for further recommendations and advice.
• Wear socks at night if your feet get cold to avoid possible irreversible abnormal sensations.
• Wear protective footwear at the beach, swimming pool or on hot pavement to avoid potential cuts or abrasions.

KEEP ACTIVE TO PROMOTE MUSCLE STRENGTH AND GOOD BLOOD FLOW TO YOUR FEET

• Wiggle your toes and move your ankles up and down for 5 minutes, 2-3 times per day. This will aid in maintaining strength and flexibility.
• Keep awareness on long walks and remember to periodically remove your shoes and socks, checking for signs of redness or bruising.
•  If you smoke tobacco products, you MUST stop. Smoking damages blood vessels by decreasing the ability to deliver oxygen to your skin. When combined with diabetes, smoking significantly increases your risk of amputation.

If you have any questions regarding good foot health practices for your specific needs, contact the Weil Foot & Ankle Institute right away to schedule an evaluation. Our doctors can make sure that you take the right steps to monitor and treat your feet, and help you to maintain your foot and ankle health for years to come.

Joakim Noah: The Real Prognosis

By: Lowell Weil Jr., DPM 

Last Friday, when the Bulls’ starting center Joakim Noah turned his ankle under his leg in a gruesome position, and the typically classless Philadelphia fans (I know...I did my residency there) cheered his injury, the Bulls’ hopes of progressing through the playoffs may have died. Bulls fans around the country held their breaths as they watched yet another star player go down in excruciating pain.

Fortunately, X-rays did not find an ankle fracture, but we can be sure that he suffered a severe sprain.

So, what exactly is a “sprain” you ask?

A sprain occurs when ligaments (tissues that connect bone to bone) are injured.  This injury can take the form of a stretch or a tear.

In Joakim Noah’s case there are many ligaments around the ankle that could have been injured, however, it was most likely the lateral (outside) ankle ligaments and/or the syndesmotic ligament (high ankle sprain). 

Regardless, I know this injury is going to take a while to get better.  While Bulls staff members keep telling the media that whether or not Joakim Noah will play will be a “game time decision,” his chances of playing in the foreseeable future do not seem likely. He is still limping with a walking boot on his foot and ankle.

I have had an opportunity to get to know Joakim a little bit, and I will say that he is a very tough guy.  As most Bulls fans may already know, Joakim will do anything possible to get himself ready to get back on the court and help his teammates win.  I have also found him to be a very nice and thoughtful person.  Once when I saw him, my nine-year-old son was with me and Joakim couldn’t have been nicer to him. My son still talks about it to this day.

You can be sure that under the direction of the Bulls’ head trainer Fred Tedeschi, Joakim is getting around-the-clock care to try and get him ready to play as soon as possible. 

So, here’s hoping that Joakim can make a quick recovery to what appears to be a very tough injury and help propel the Bulls further in the playoffs.  If it doesn’t turn out to happen this year, Joakim will certainly be ready to help the Bulls achieve their goal of an NBA Championship in 2012-2013.

Are You Ready For Pedicure Season?

By: Williette Nyanue

I think that we’ve been tricked here in Chicago. We started off with a beautiful early spring, and the weather was consistently in the upper 70s and 80s. Now it seems we can’t get a day above 70! Nevertheless, we all know that warmer weather is around the corner. As Dr. Weil Jr., noted in his previous blog post, for medical professionals at the Weil Foot and Ankle Institute, spring means the beginning of plantar fasciitis season. However, for most of us ladies, the beginning of warmer weather means that it’s time for us to start getting our feet primed and prepped regularly for open-toe shoe season.

As compared to many of our male counterparts, the amount of time and effort a lot of us women put into getting our feet as close to perfect as possible can seem downright unfair! There’s soaking and scrubbing, washing and massaging, clipping and filing, painting and moisturizing… There are also so many tools needed to get the job done! We use nail files and buffers, pumice stones and brushes, toenail clippers, cuticle clippers, foot scrubs, ointments, oils, lotions, corn pads and nail polish. I’ve even seen what I’m sure was a cheese grater and a machine that I swore you only used to sand uneven surfaces. 

But can we help it? During the warmer months, all of the women’s magazines have articles and slide shows with catchy titles such as,“Fix Ugly Feet at Home,” and, “9 Easy Ways to Get Super Soft Feet Just in Time for Summer.” In these magazines we can find all of the great summer nail polish trends for our next pedicure, as well DIY options to make sure that when you’re caught in your open-toe sandals, you have nothing to worry about. The articles all basically remind us of one thing: Having “pretty” feet for the summer should not be an option, it should be a necessity.

Although many women would cite pedicures as relaxing midday or weekend treats, trips to the nail salon can be a hassle with long wait times, expensive prices and did I mention how much that pumice stone tickles?

It may seem that we go through unnecessary lengths just to get ourfeet “pretty” for the warmer months, but all of this effort is not in vain. I’m not just talking about the compliments that you get either. Getting proper, professional pedicures is actually good for the overall health of your feet.  While a podiatrist should look at more serious foot problems such as bunions, hammertoes and infected, ingrown toenails, pedicures can actually play a part in the prevention and aid of some minor and aesthetic foot problems. According to Dr. Weil, Jr., “Pedicurists are trained to manage nails properly. They know how to cut them and the right shape to create because not all nails should be cut the same. Additionally, pedicurists have the proper instrumentation to handle more difficult nails, which are quite common.” Dr.Weil Jr. also notes that getting proper pedicures may be increasingly important for older men and women and those with medical conditions like diabetes. He states, “As we get older, it is more difficult for us to get our hands, and more importantly our eyes, to the level to properly cut a nail. By not being in the right place with our hands or eyes, we could cut the nail incorrectly. This could lead to ingrown toenails, infections, lacerations or wounds.” Pedicurists can also aid in the prevention of painful calluses and corns by sloughing off dead skin that accumulates on your feet over time.

So, as temperatures increase and you think about skipping out on the occasional pedicure because of the inconvenience or hassle that it may cause, remember that not only will pedicures make your feet look pleasing; they can also increase the overall health of your feet. We are constantly abusing our feet. Why not give them a bit of TLC once in a while?

For all of you men out there, you heard it from a doctor himself. Pedicures are good for everyone! Invest in one…just skip the nail polish if you want.

I know we’re ready for the open-toe shoe season here at the Weil Foot and Ankle Institute. Are you?

Are you looking for somewhere to get a professional pedicure? What better place to have one done than a podiatry clinic? The Weil Foot and Ankle Institute offers professional pedicure services throughout the week at our Des Plaines office. If you are in the area, stop by the clinic or call 847-390-7666 to set up your pedicure appointment today! 

Podiatry Today's Current Concepts in Plantar Plate Repair

Current Concepts In Plantar Plate Repair

• Volume 25 - Issue 4 - April 2012
 
• 2867 reads
 
• 1 comments

Author(s): 

 Lowell Weil Jr., DPM, FACFAS, and Erin E. Klein, DPM, MS

Do you find yourself in certain cases choosing between metatarsal realignment and plantar plate repair? Given this dilemma, these authors suggest that combining the Weil osteotomy with a dorsal approach to the anatomic plantar plate may be beneficial in addressing both plantar plate tears and metatarsalgia.

With any surgical procedure, there are problems and complications. The most commonly discussed problem associated with the Weil osteotomy is the “floating toe.” Studies had identified the floating toe to occur 15 to 50 percent of the time following a Weil osteotomy.^1-3 The floating toe does not touch the floor with neutral weightbearing after undergoing a metatarsal osteotomy.

   Additionally, there is weakness and decreased ability to plantarflex the toe actively. Many have theorized as to the cause of floating toe and have suggested modifications to the procedure in order to prevent its occurrence.^4-7 However, most of these changes have not altered the outcome and increased other complications (transfer metatarsalgia, stiffness, edema, etc.) and disability postoperatively.

   For years, we have been trying to find a solution to the problem, whether it is making sure to perform the procedure in the articular surface to prevent plantar translation, performing appropriate dorsal soft tissue release, encouraging early physical therapy (seven days postoperative), and emphasizing plantarflexion strength and night splinting of the toe. Nonetheless, floating toe still occurred, although at rates much lower than cited in the literature. In our most unstable metatarsophalangeal joints (MPJs), we started trying to repair the plantar plate in conjunction with the osteotomy but with limited success due to the difficulty of exposure from the dorsal approach.

   In the fall of 2007, the lead author had given a lecture on the Weil osteotomy at a Podiatry Institute conference in Florida. Immediately following the lecture, Craig Camasta, DPM, gave a lecture on plantar plate pathology and repair. Dr. Camasta was one of the real leaders in discussing the plantar plate and he made a very compelling argument as to the role of the plantar plate in lesser metatarsophalangeal joint problems. Listening to Dr. Camasta’s rationale made the lead author strongly consider the possibility that plantar plate insufficiency may have more to do with the painful metatarsalgia entity and postoperative floating toe problems than previously appreciated. It also made him think that combining the Weil osteotomy with a plantar plate repair would be the best of both worlds...

Read the rest of the article here!