Weil Foot & Ankle Institute

Chicago Marathon Study

2011-10-10T09:09:00.001-05:00

Calling all marathoners! We would love your input in our marathon shoe & injury survey - http://www.weil4feet.com/marathonstudy - as a thank you for your time, you will recieve a coupon for our online doctors store! we would LOVE to hear your feedback!!!!! :)

Patient Experience: Able to Run Again

2011-05-02T22:14:00.000-05:00

Dr. Weil,

I was going through some things today and found your card. You performed some "clean up" surgery on my heel in Nov. 2000.

Thanks to you I have been able to run again and am participating in a 10K tomorrow. I am also the mother of two beautiful girls Lowrie (8) and Sara (5 today!)

Thank you for all your help years ago. I remember telling you that my goal was to run again. It didn't take a decade but I wanted to let you know.

Sincerely,

Louise

Shockwave Therapy Effective for Treating Heel Pain

2010-08-18T10:32:00.000-05:00

FOOT AND ANKLE
ORTHOPEDICS TODAY July 1, 2010

Shock wave therapy effective for chronic heel pain in randomized, prospective trial
Visual Analog Scale pain scores at 12 months post-treatment dropped 7.5 points from baseline and those patients reported no major adverse events.

Investigators for a multicenter study found that extracorporeal shock wave therapy safely and effectively reduced recalcitrant chronic plantar heel pain, according to findings from their randomized placebo-controlled trial.

“The focused extracorporeal shock wave therapy (ESWT) as applied in this study shows statistically and clinically relevant results with a much better outcome in the active group,” compared to the control group, Ludger Gerdesmeyer, MD, of Kiel, Germany, said at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.

In the ESWT study group, “We have found no relevant side effects,” Gerdesmeyer said. The data he presented have been submitted to the U.S. Food and Drug Administration for possible clearance of the Duolith SD1 (Storz Medical) used in the study for this indication.

The 250-patient study was conducted at European and U.S. centers. Investigators enrolled patients from each center with chronic plantar heel pain of greater than 5 on the Visual Analog Scale (VAS) that did not respond to conservative care.
Focused ESWT

After a wash-out period, patients were randomized to either the active or control group. The active group received 0.25 mJ/mm2 ESWT, 4 Hz frequency, with the device focused on the site of heel pain without the aid of any radiography. Patients in the control group underwent a sham treatment where the ESWT device was deactivated but used identically.

Patients underwent three treatments each. Their results were assessed at 3 months and 12 months following their last treatment using the VAS pain scores as the main outcome measure. Results of the Roles and Maudsley patient self-assessment score and the SF-36 score served as secondary outcomes.

At 3 months, baseline composite VAS scores of 8.3 decreased to 2.7 points after ESWT in the active group and decreased to 5.3 points in the control group. In the ESWT group, VAS scores further decreased after 12 months to 0.8 points.
Less pain

“In the active group we have 69% of the patients [having] more than 60% pain reduction compared to baseline,” Gerdesmeyer said. By comparison, sham treatment was associated with more than 60% pain reduction in 34% of control patients, he said.

Differences between the baseline and follow-up secondary outcomes also favored the active group.

No major adverse events occurred related to ESWT treatment. Some patients treated with ESWT, however, reported device-related events including slight pain or discomfort during and after treatment and minor local swelling or redness.

“It was interesting to see that placebo patients getting just a sham treatment also reported pain during treatment,” Gerdesmeyer added. — by Susan M. Rapp

Reference:

* Gerdesmeyer L, Gollwitzer HW, Saxena A, et al. Focused shock wave therapy in chronic plantar heel pain: A randomized placebo controlled trial. #706. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.

Ludger Gerdesmeyer, MD, can be reached in the Department of Orthopedics and Traumatology, Klinikum Recht der Isar, Technical University Munich, Insmaniger Str. 22, Munich, Germany; 49-89-41402271; e-mail: gerdesmeyer@aol.com.

Perspective

Carol C. Frey, MD
Carol C. Frey

Published studies report that more than 2 million patients are treated for plantar fasciitis each year, accounting for approximately 11% to 15% of all foot-related encounters with physicians annually. Plantar fasciitis is a painful inflammatory process that when not treated can evolve into chronic degenerative changes in the fascia. Traditional treatment options, including conservative measures and medication, have shown success rates from 44% to 82%. Surgical intervention with open or endoscopic release of the plantar fascia has unpredictable results, substantial risks and recovery is usually very slow — 1 year. Researchers have been building a strong body of published clinical evidence for ESWT. ESWT has been shown to be safe and effective in several prospective randomized studies including studies by Gerdesmeyer. In cases of failed nonsurgical treatment, ESWT represents an excellent option to surgery and radial ESWT may be a better option than focused ESWT, as anesthesia is not required.

– Carol C. Frey, MD
Foot & Ankle Section Editor
Orthopedics Today

Foot Woes Keeping Him on His Toes

2010-08-16T10:34:00.002-05:00

Podiatrist Lowell Weil Sr. had to travel to Papua New Guinea to find people without any foot problems.

"I went there to look at their feet because there'd been a paper written that showed that none of them had bunions. In fact, they have big toes that go out in the other direction," he said, noting the natives never wore shoes. "I had to see it for myself and I did. I took hundreds of pictures of the natives sticking their feet out."

Dr. Lowell Weil Sr. in an office at the Weil Foot and Ankle Institute in Des Plaines. Weil is a long-time Glenview resident and is known as the pioneer of shockwave treatment for heel pain.
(Allison Williams/Staff Photographer)

That solidified for Weil that shoes are a big culprit in aggravating bunions, although not necessarily causing them.

Weil, medical director of the Weil Foot and Ankle Institute in Des Plaines, has seen a lot of bunions, flat feet and other painful conditions below the ankle in 45 years of practice.

His specialty is the front part of the foot, where he designed an operation to shorten a bone causing pain under the ball of the foot that a French orthopedic surgeon named for him.

"I was in France lecturing. Somebody asked me from the audience, 'What do you do for this condition?' and there was a blackboard back in those days and I drew a picture. The next thing I knew, I came back to America and a friend of mine, an orthopedic surgeon, said to me, 'What the hell is this Weil osteotomy?'"

Most recently, he and his son, Lowell Weil Jr. of Lake Forest, who's part of the practice, lectured to a Chicago audience about the results of a nine-year study that showed sonic shockwave therapy has been effective in treating plantar fasciitis, a common form of heel pain.

Weil Sr. is also an expert in the "Refrigerator stepped on me" condition -- a reference to the jokes he heard from teammates of former Chicago Bear William "Refrigerator" Perry during the 25 years he spent as the football team's podiatrist.

Weil grew up in Skokie, where his parents long ran Weil Women's Clothing in downtown Skokie.

He settled with his wife, Nancy, in Glenview 37 years ago, in a house once owned by former Illinois Governor Otto Kerner.

Weil served on the Glenview Village Board from 1986 to 1990. His wife was on the Glenview School District 34 Board from 1980 to 1987.

Now a grandparent of six, Weil balances work with time at their second home in Mexico and travel.

"It's fun to be able to help people and meet the kind of people we meet," he said. "I never thought I'd be able to lecture in 29 countries and travel everywhere. I thought I'd have a nice little practice in Des Plaines, Ill. but it turned into something more than that."

-- Lynne Stiefel

Originally published August 10, 2010 in Glenview Announcements

Study Shows ESWT an Effective Non-Surgical Alternative

2010-07-29T09:25:00.002-05:00

The doctors of the Weil Foot & Ankle Institute have studied, published on and utilized Extracorporeal Shock Wave Therapy (ESWT) for years to treat patients with heel pain and other painful conditions of the foot and ankle. The studies commented on below are another confirmation that ESWT can be an effective non-surgical alternative to treating pain. From Orthopedics Today:

Published studies report that more than 2 million patients are treated for plantar fasciitis each year, accounting for approximately 11% to 15% of all foot-related encounters with physicians annually. Plantar fasciitis is a painful inflammatory process that when not treated can evolve into chronic degenerative changes in the fascia. Traditional treatment options, including conservative measures and medication, have shown success rates from 44% to 82%. Surgical intervention with open or endoscopic release of the plantar fascia has unpredictable results, substantial risks and recovery is usually very slow — 1 year. Researchers have been building a strong body of published clinical evidence for ESWT. ESWT has been shown to be safe and effective in several prospective randomized studies including studies by Gerdesmeyer. In cases of failed nonsurgical treatment, ESWT represents an excellent option to surgery and radial ESWT may be a better option than focused ESWT, as anesthesia is not required.

– Carol C. Frey, MD
Foot & Ankle Section Editor
Orthopedics Today

IL Podiatrist Questions Heel Pain Study's Conclusions

2010-07-17T10:30:00.000-05:00

Women who habitually wear high heels have shorter muscle fibers in their calves and thicker Achilles' tendons than those who walk in flat shoes, researchers say. The result? The heel lovers’ tendons stiffen and become harder to stretch, which could explain why walking hurts after kicking off the Jimmy Choos, according to a small study published in the Journal of Experimental Biology. The researchers found that wearing heels affected muscle fiber length--the high heel wearers' muscle fibers were 13 percent shorter than those who wore flat shoes. For some women, once the heels come off, the pain starts because the muscles can't stretch enough, the researchers said.

Wearing a variety of different types of shoes and stretching may help alleviate the pain, according to the study authors. But Chicago podiatrist Steve Weinberg, who was not involved with the study, questioned whether it's possible to stretch the Achilles tendon enough to make a clinical difference. "If women are going to wear high heels, they should be prudent—stand or walk in them for a short time,” said Weinberg, a podiatrist at the Weil Foot & Ankle Institute and the longtime chief podiatrist for the Chicago Marathon.

Source: Julie Deardorff, Chicago Tribune [7/16/10]

Patient Experience: Conservative Treatment for Stress Fracture

2010-07-15T09:03:00.002-05:00

When stress fractures occur in the foot or foreleg, one course of action is to fit the patient with a walking boot which offloads pressure from the injury. A doctor and colleague of our Dr. Jeff Baker recently experienced this treatment protocol firsthand. Read about her experience with a walking boot here.

Efficacy of Outpatient Bilateral Simultaneous Hallux Valgus Surgery

2010-06-10T10:18:00.000-05:00

Abstract

Bilateral simultaneous hallux valgus correction is traditionally performed as an inpatient procedure due to concerns regarding adequate postoperative analgesia and difficulty mobilizing. We prospectively evaluated 40 consecutive patients (80 feet) who underwent outpatient surgical correction of bilateral symptomatic hallux valgus. Patients underwent preoperative radiological and clinical assessment using pain and American Orthopaedic Foot & Ankle Society (AOFAS) hallux assessment scores. Patients underwent preoperative counseling and were assessed for medical suitability for outpatient surgery. They were instructed to have responsible adult caregivers available for 24 hours postoperatively, easy access to after-hours emergency medical care, and access to a telephone. Procedures were performed under general anesthesia with local anesthetic ankle block.

Postoperatively, patients were discharged after assessment by medical, nursing, and physiotherapy staff with an oral analgesia regimen. Cast immobilization was not used. Patients were reviewed at 6 weeks and 3 months postoperatively with repeated clinical and radiological assessment. All patients were discharged home and none required inpatient ward admission. Post-discharge, no patient presented to the emergency department or their general practitioner as a consequence of poor pain control. At final follow-up assessment, mean AOFAS hallux scores had improved from 58.1 (range, 29-80) to 89.0 (range, 47-100) (P<.001). The mean hallux valgus angle improved from 33.2° (range, 15°-53°) to 16.9° (range, 3°-39°) and the intermetatarsal angle had improved from 13.2° (range, 6°-23°) to 8.5° (range, 4°-15°) (P<.001). Eighty-five percent of patients reported that they would recommend outpatient surgery. Bilateral hallux valgus surgery can be performed safely as an outpatient procedure in selected patients with acceptable levels of patient satisfaction.

An increasing number of orthopedic surgeries are now performed as outpatient procedures.^1,2 The clinical and economic benefits of outpatient surgery extend to the patient and the health care provider. Hospital stays are shorter, patients are able to recover in their own home environment, surgery cancellations due to inpatient bed shortages are unlikely, and the risks of hospital-acquired infection are reduced.^1,2

Published results of unilateral hallux valgus correction as an outpatient procedure indicate that it can be undertaken safely with a high degree of patient satisfaction.^3,4 However, hallux valgus has been reported to affect both feet in as many as 84% of cases.^5,6 As such, surgical correction of bilateral, symptomatic hallux valgus normally involves an inpatient admission due to concerns regarding postoperative pain control, or alternatively, 2 separate outpatient procedures. Performing this surgery as an inpatient procedure means that the institution cannot make use of the potential benefits of the outpatient surgery unit. Similarly, performing staged unilateral surgical corrections has social and economic implications for patients, as they must effectively recover from 2 separate surgical procedures.

This article reports the outcomes of bilateral corrective surgery for hallux valgus in a selected patient population.

Materials and Methods

Forty consecutive patients (80 feet) who presented to the outpatient surgery unit at our institution for surgical correction of bilateral hallux valgus were prospectively evaluated. Suitable patients were selected from those attending a specialist foot and ankle service with bilateral symptomatic hallux valgus.

Patient suitability was determined by assessing their medical and social circumstances. Clinical assessment for medical suitability for outpatient surgery was undertaken by a specialist nurse/anesthesiologist. Individuals who were American Society of Anesthesiologists (ASA) grades 1 and 2 were deemed suitable, along with those who were grade 3, providing their disease was well controlled. A body mass index (BMI) of ≤35 was also required. Each patient was counseled about the social and medical implications of having the procedure performed as an outpatient and was provided with an information sheet. In addition to being considered medically suitable for outpatient surgery, patients were instructed that they must have a responsible adult caregiver available for a minimum of 24 hours postoperatively, easy access to after-hours emergency medical care, and immediate access to a private telephone (Table 1).

Patients underwent preoperative clinical scoring using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux assessment scoring system in addition to radiological assessment by dorsoplantar, oblique, and lateral weight-bearing radiographs of the feet (Figure 1). Preoperative pain scores were also recorded.

Figure 1: Preoperative radiographs of a patient with bilateral hallux valgus and varus deformity of the fifth metatarsophalyngeal joints.

All patients were admitted to a dedicated outpatient surgery ward on the day of the intended procedure. All procedures were performed under general anesthesia with local anesthetic ankle block for postoperative analgesia using the maximal individual dose of levobupivicaine (2 mg/kg). Surgeries were performed using pneumatic tourniquets with exsanguination using an Eshmarch bandage. Both feet were draped simultaneously. A number of surgical procedures have been described to correct the deformity of the first ray in hallux valgus, and several authors have published treatment algorithms to simplify the surgical management of this condition.^5,7-15 As such, the surgical procedure depended on a number of factors, including the degree of radiological deformity (hallux valgus and intermetatarsal angles) and the presence or absence of tarsometatarsal joint instability, first metatarsophalyngeal arthritis, and hallux valgus interphalangeus. Patients who required treatment of fixed lesser toe deformities in addition to the bilateral first ray deformity were not considered suitable for bilateral outpatient correction.

Postoperatively, patients were discharged after assessment by medical, nursing, and physiotherapy staff. Each patient was discharged with a standardized oral analgesia regimen (altered if potential drug allergies or interactions were reported), which included diclofenac sodium 50 mg three times daily, acetaminophen 1000 mg 4 times a day, and dihydrocodeine 30 mg to be taken as necessary for 10 days. Each patient was given an information sheet and was advised to contact the orthopedic unit, the after-hours emergency medical service, or the hospital emergency department immediately if any postoperative complications occurred. Patients were reviewed 10 days postoperatively in a nurse-led foot clinic for wound inspection, suture removal, and reduction of dressings. Cast immobilization was not used, and all patients were instructed to bear weight with the heel only for the first 6 weeks postoperatively.

Patients were subsequently reviewed at routine outpatient clinics 6 weeks and 3 months postoperatively. At 3-month follow-up, radiographs were taken as previously described to document the radiological outcome of surgery (Figure 2). Clinical evaluation was repeated using AOFAS hallux scores and pain scores.

Figure 2: Postoperative radiographs after correction with bilateral chevron/akin osteotomies and osteotomies of both fifth metatarsals performed as outpatient procedures.

Statistical analysis was performed using SPSS 13.0 software (SPSS Inc, Chicago, Illinois). Comparison of postoperative outcome scores was performed using the Mann-Whitney test.

Results

All 40 patients (80 feet) successfully underwent bilateral corrective surgery. The mean age of the study population was 45 years (range, 17-69 years; SD ±15.9). Thirty-nine (97.5%) of the 40 patients in the study group were women. The surgical procedures performed and the indications are listed in Table 2.

All patients were discharged home successfully from the outpatient surgery unit, and no patient had to be transferred to the inpatient ward prior to discharge.

One patient (2.5%) presented to her general practitioner in the perioperative period with a superficial wound infection, which was successfully treated with a course of oral antibiotics.

Clinical and radiological outcomes were documented at a mean follow-up of 3.2 months (range, 1.4-4.6 months), and a statistically significant improvement was noted in both of these outcome measures (P<.001; Table 3).

Patients were also surveyed to determine whether they would undergo the procedure again or recommend it to a friend based on their recent experience. Eighty-five percent of patients (34 of 40) reported that they would do so, and 15% (6 of 40) reported that they would in retrospect have preferred the procedure to be undertaken as an inpatient with an overnight stay. Reasons cited for this included postoperative pain (2), difficulties with mobilizing at home (2), and a desire to recover in an inpatient ward-based environment despite adequate analgesia (2).

A number of postoperative complications were recorded, including 1 postoperative superficial infection; 1 case of persisting metatarsalgia; 1 case of persistent pain due to prominent metalwork, which required removal; and 1 deformity recurrence requiring revision surgery. One patient suffered a traumatic fracture of the first metatarsal after tripping while walking after the original osteotomy had successfully healed. No symptoms were reported preinjury, and the fracture healed with conservative management. No further surgery was indicated or performed. All osteotomies and fusions progressed to radiological union.

Discussion

Dedicated outpatient surgery units are more resource efficient and allow a surgical department to release inpatient beds for more major cases.^1,2 Advances in anesthetic techniques have resulted in an increasing number of procedures being offered as outpatient surgeries.¹ Several studies have reported favorable outcomes after unilateral hallux valgus correction as a outpatient procedure.^3,4,6 However, hallux valgus is frequently a bilateral condition, and performing staged unilateral surgical corrections has social and economic implications to patients, as they must recover from 2 separate surgical procedures. A single procedure is associated with increased operating time, increased postoperative pain, and difficulty mobilizing.¹⁶

When a surgical procedure is offered on an outpatient basis, it is essential to ensure that a number of caveats are met. The procedure must be suitable for such a setting, the risk of early postoperative complications (from surgery and anesthetic) should be minimized, and admission to an inpatient ward postoperatively should be unlikely. We have demonstrated that bilateral hallux valgus correction adequately satisfies these criteria. In addition, objective measures of clinical and radiological outcomes were highly satisfactory, and patient satisfaction was similar to that reported for unilateral outpatient hallux valgus surgery.^3,4

To avoid readmission, it is essential that the home circumstances of any patient considered for bilateral outpatient surgery are carefully considered. If a patient does not meet our criteria for domestic support, an inpatient admission is offered. In addition, it is essential that a patient is properly informed of the potential problems that may arise in the early postoperative period and that the patient should be suitably motivated to undergo such surgery.

The provision of adequate postoperative analgesia is also fundamental to the success of this procedure, and the effective use of nerve blocks to achieve this is a key factor in extending the indications of outpatient surgery to bilateral hallux valgus corrective surgery. The safety and efficacy of peripheral nerve blocks in foot and ankle surgery have been well established, and levobupivicaine is a safe, effective local anesthetic agent able to provide analgesia for up to 10 hours postoperatively.^17,18 As such, no patient in this study required increased analgesia above the oral agents prescribed on discharge from the outpatient surgery unit.

Performing bilateral hallux valgus surgery may in theory increase the risk of certain postoperative complications, such as loss of fixation and deep venous thrombosis; however, no such problems were identified in this patient cohort.

Conclusion

Bilateral hallux valgus surgery can be performed safely on an outpatient basis in selected patients with acceptable levels of patient satisfaction. To our knowledge, this has not been previously reported in the literature.

References

Department of Health. Day surgery: operational guide: waiting, booking and choice. London, England: Department of Health; August 2002.
Aylin P, Williams S, Jarman B, Bottle A. Trends in day surgery rates. BMJ. 2005; 331(7520):803.
Bhargava A, Rai P, Shrivastava RK. Adult day case hallux valgus surgery—a safe and viable option. Ambulatory Surgery. 2003; 10(3):151-154.
Tibrewal SB, Foss MV. Is day surgery for Wilson’s osteotomy safe? J Bone Joint Surg Br. 1991; 73(2):340.
Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007; 28(7):759-777.
Thomas S, Barrington R. Hallux valgus. Current Orthopaedics. 2003; 17(4):299-307.
Barouk LS. Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures. Foot Ankle Clin. 2000; 5(3):525-558.
Borton DC, Stephens MM. Basal metatarsal osteotomy for hallux valgus. J Bone Joint Surg Br. 1994; 76(2):204-209.
Coughlin MJ, Saltzman CL, Nunley JA II. Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopaedic Foot & Ankle Society on angular measurements. Foot Ankle Int. 2002; 23(1):68-74.
Coull R, Stephens MM. Operative decision making in hallux valgus. Current Orthopaedics. 2002; 16(3):180-186.
Easley ME, Trnka HJ. Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int. 2007; 28(6):748-758.
Johnson KA, Cofield RH, Morrey BF. Chevron osteotomy for hallux valgus. Clin Orthop Relat Res. 1979; (142):44-47.
Lapidus PW. The author’s bunion operation from 1931 to 1959. Clin Orthop Relat Res. 1960; (16):119-135.
Mitchell CL, Fleming JL, Allen R, Glenney C, Sanford GA. Osteotomy-bunionectomy for hallux valgus. J Bone Joint Surg Am. 1958; 40(1):41-58.
Robinson AH, Limbers JP. Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br. 2005; 87(8):1038-1045.
Lin JS, Bustillo J. Surgical treatment of hallux valgus: a review. Curr Opin Orthop. 2007; 18(1):112-117.
Dhukaram V, Kumar CS. Nerve blocks in foot and ankle surgery. Foot Ankle Surg. 2004; 10(1):1-3.
Gottschalk A, Burmeister MA, Radtke P, et al. Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Anesth Analg. 2003; 97(4):1086-1091.

Authors

Messrs Murray, Holt, Crombie, and Kumar and Mss McGrory and Kay are from the Department of Orthopedic and Trauma Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.

Messrs Murray, Holt, Crombie, and Kumar and Mss McGrory and Kay have no relevant financial relationships to disclose.

Correspondence should be addressed to: Graeme Holt, FRCS(Tr&Orth), Department of Orthopedic and Trauma Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom (graemeholt@btinternet.com).

doi: 10.3928/01477447-20100429-09

Study of Microfracture of the Ankle

2010-05-18T09:02:00.000-05:00

The recent article in the publication Foot and Ankle International has shown excellent results with microfracture of the ankle in a wonderful study.

This research mirrors what arthroscopic ankle specialists Dr. Jeffrey Baker and myself have seen with our patients.

Lowell Weil, Jr., DPM, MBA, FACFAS
Fellowship Director, Weil Foot & Ankle Institute
Team Podiatrist, Chicago White Sox

Second-Look Arthroscopic Findings and Clinical Outcomes After Microfracture for Osteochondral Lesions of the Talus

Keun-Bae Lee, MD, PhD†‡*,
Long-Bin Bai, MD†‡,
Taek-Rim Yoon, MD, PhD†‡,
Sung-Taek Jung, MD, PhD† and
Jong-Keun Seon, MD†
+ Author Affiliations
† Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
‡ The Brain Korea 21 Project, Center for Biomedical Human Resources at Chonnam National University, Gwangju, Korea
*Address correspondence to Keun Bae Lee, MD, PhD, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 8 Hakdong, Donggu, Gwangju, 501-757, Korea (e-mail: kbleeos@chonnam.ac.kr).

Abstract

Background Arthroscopic microfracture is frequently used to repair osteochondral lesions of the talus. However, despite the popularity of this technique, no study has been conducted on cartilage repair after microfracture by second-look arthroscopy.

Purpose The purpose of the present study was to evaluate cartilage repair in osteochondral lesions of the talus by second-look arthroscopy and to compare arthroscopic findings with clinical outcomes 12 months postoperatively.
Study Design Case series; Level of evidence, 4.

Methods Second-look arthroscopies were performed in 20 ankles of 19 patients at 12 months postoperatively. Arthroscopic findings were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the International Cartilage Repair System (ICRS). Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.

Results According to the Ferkel and Cheng staging at second-look arthroscopy, 7 of the 20 ankles (35%) showed incomplete healing (stage D). In terms of ICRS overall repair grades, 8 ankles (40%) were abnormal (grade III). Mean AOFAS scores for Ferkel and Cheng stages A to C (n = 13) and stage D (n = 7) were 88.5 and 82.0 points, and those for ICRS repair grades I and II (n = 12) and grade III (n = 8) were 88.7 and 82.5, respectively. Good correlations were found between AOFAS scores and Ferkel and Cheng stages and ICRS grades. Overall, 90% of ankles achieved an excellent or good AOFAS score of over 80 points.

Conclusion Second-look arthroscopic findings at 12 months postoperatively after microfracture for osteochondral lesions of the talus revealed that 40% of lesions were incompletely healed. Nevertheless, the majority of patients achieved a good clinical outcome. Furthermore, postoperative clinical scores were found to be correlated with ICRS repair grades.

Dr. Jeff Baker Nominated for Man of the Year by the Leukemia & Lymphoma Society

2010-03-23T09:41:00.002-05:00

Dear Friends and Colleagues,

I am a person who believes in giving back and this year I wanted to do something big. Today I launch my campaign for the Man & Woman of the Year, a fundraising effort of the Leukemia and Lymphoma Society. The mission, to cure blood cancer and improve life for patients and their families.

I have built a connection to The Leukemia & Lymphoma Society over the past several years due to my friendship with Mike Odisho. His father passed away from Leukemia in 1998. Mike has given his heart and soul to this cause over the years and I was honored when as member of the Man & Woman of the Year nominating committee, he nominated me.

I am excited to announce that my challenge to raise $10,000 for the Leukemia & Lymphoma Society. My campaign starts today and lasts for the next 10 weeks. The money I raise will help find cures for blood cancers and improve the quality of life for patients and their families. I am viewing this challenge as way to honor all who have been affected by cancer. Given their struggles, it is the least I can do.
Why LLS? Because it’s the world’s largest voluntary health organization dedicated to fighting blood cancer and I want to help fight cancer. The Man & Woman of the Year campaign is in its tenth year and maintains an exceptional cost/income ratio – over 86 cents of each dollar nationally directly funds the mission.

I’m also participating in honor of the Girl of the Year, Rachel Williams. Rachel is a 6- year-old who has recently finished two and a half years of chemotherapy, spinal taps, and bone marrow testing. She is now in a “wait and see period” to find out if the treatments worked. Rachel loves to participate in cheerleading, horseback riding, gymnastics, and school. Meeting Rachel and hearing her story really affected me. Her mom spoke of how this journey started, fatigue and weakness initally diagnosed as mono. Rachel is a sparkplug of hope and determination. Meeting and talking with her was an experience I will never forget. She was so full of life, something we all take for granted everyday. I want to help make sure all children affected by blood cancer are able to have a happy, healthy and fun-filled childhood. I hope you can help me with that vision.

Here is how the Man & Woman of the Year campaign works: I am a candidate. You “vote” for me by donating to my campaign. If I receive the most votes (dollars), I will be named the 2010 Man of the Year. You will then see my picture on taxi rooftop ads in Chicago. If you are really generous I may become the national winner and be featured in USA Today.

There are a variety of ways in which you can contribute to my campaign, and to cures for cancer. Any donations will be a great help towards the mission. Here are some options:

¨ Donate online at http://il.mwoy.llsevent.org/jbaker. You will be directed to a secure site to make your donation.
¨ Attend my future fundraising events. Information on these events will be available soon.
¨ Send a check, made payable to The Leukemia & Lymphoma Society. Be sure to put my name in the memo line and send to LLS at 651 W. Washington Blvd., Suite 400 Chicago, IL 60661
¨ Corporate sponsorship
¨ Send my website to your friends; http://il.mwoy.llsevent.org/jbaker.
¨ Donate an item for my silent auction (time shares, sports tickets, airline miles)

Remember, 86% of each donation raised nationally will directly fund the mission of The Leukemia & Lymphoma Society. Thank you so much for your support of me and The Leukemia & Lymphoma Society.

Jeff Baker, DPM, FACFAS

ESWT for the Treatment of Plantar Fasciitis: A Nine-Year Follow-Up

2010-02-25T14:23:00.003-06:00

ESWT for the Treatment of Plantar Fasciitis: A Nine-Year Follow-Up

Kelly A. Malinoski, DPM, Lowell Weil Jr., DPM, Lowell Scott Weil, Sr., DPM

Anthony Borrelli, DPM, Wendy Benton-Weil, DPM

WEIL FOOT AND ANKLE INSTITUTE, DES PLAINES, IL www.weil4feet.com

Introduction

Extracorporeal Shockwave Therapy (ESWT) is a well-accepted treatment alternative, world wide, for the treatment of chronic and recalcitrant tendonopathies and plantar fasciitis. Early and mid-term study results indicate success with a variety of orthopedic disorders, including plantar fasciitis. While several short-term studies support ESWT for the treatment of plantar faciitis1,2, there are only a few mid-term studies that have evaluated the benefit of ESWT on function and pain five years post-treatment. These studies demonstrate favorable results including improved function and pain .3,4

Objective

To determine the long term benefit (9 years) and safety of ESWT on patient reported measures of function, pain, patient satisfaction, and level of improvement and time necessary to resume regular activities. Safety measures evaluated whether there was any history of long-term weakness, lateral column pain, or plantar fascial rupture that could be attributed to the ESWT intervention.

Methods

Study Design

The number of patients with plantar fasciitis treated with ESWT in 2001-2002 was identified using retrospective chart review (N=197).

Data Collection

A 10-item paper pencil retrospective survey was mailed to each patient and was used to document level of function, pain, patient satisfaction, level of improvement, time necessary to resume regular activities, and complications.

Statistical Analysis

Descriptive statistics were used to examine the distribution for all key variables. For categorical variables (i.e., level of satisfaction, level of function, and etc..), frequency counts were calculated. For continuous variables (i.e., level of improvement, level of pain), measures of central tendency and dispersion were calculated. Additional analyses included cross tabulation and correlations of key variables to further understand the data. SAS version 9.1 was used for all analyses.

Results

Of the 197 patients identified for inclusion in the study, 75 patients returned the survey (38.1%).

SATISFACTION

65 patients (87.84%) reported moderate to high satisfaction with ESWT.
Of those patients, 58 reported high satisfaction. For those patients, the percentage of improvement in heel pain was 96.4% (SD=6.16) with an average pain rating of 0.77 (SD=1.10) after the procedure.

ACTIVITY

Of the 63 patients (87.50%) able to return to regular activities after ESWT, the amount of time was 3.44 weeks and average pain rating after the procedure was 1.21.

PAIN

There was a significant negative correlation between percentage of improvement in heel pain and average pain rating after the procedure (r=-0.801, p < 0.001).

18 patients (24.3%) were able to discontinue comfort maintenance (i.e., stretching, icing and etc..) after ESWT. For those patients, percentage of improvement in heel pain was 95.8% (SD=7.72) with an average pain rating of 0.67 (SD=1.19) after the procedure. For the remaining 56 patients who continued maintenance, the percentage of improvement in heel pain was 79.7% (SD=32.60) with an average pain rating of 2.07 (SD=2.77).

FUNCTION

Of the 66 patients (91.67%) who reported better functioning after ESWT, the percentage of improvement in heel pain was 91.09% (SD=17.38)

COMPLICATIONS

There were no long-term complications such as continued lateral column pain, neuropraxia, nerve injury, or plantar fascial rupture reported.

Table 1. Descriptive Statistics
Domain	Outcome	N=74 Patients

Satisfaction	Level of satisfaction with ESWT n (%)	65 (87.84)

Pain	Average percent improvement in heel pain (0-100%; Mean ± SD) Average heel pain rating following ESWT (0-10; Mean ± SD)	83.61 ± 29.40 1.73 ± 2.55

Function	Level of functioning following ESWT n (%)	66 (91.67)

Activity	Ability to return to regular activities n (%) Average time (weeks) necessary to return to regular activities (Mean ± SD)	4.50 ± 12.74

Conclusions

ESWT has been shown to be highly effective in treating numerous musculoskeletal conditions, including chronic plantar fasciitis, in patients as early as three months following treatment. To date, there have been no studies evaluating these patients beyond five years.

We have evaluated a limited number of patients, retrospectively, who were an average of nine-years post-ESWT treatment of plantar fasciitis. Our early results have continued to be beneficial and satisfying to the great majority of patients responding to our request for evaluation.

This leads us to a conclusion that ESWT is equivalent to open surgery for the treatment of chronic plantar fasciitis, and that the results of this treatment appears to be void of some of the complications such as chronic lateral column pain and neuropraxia that are seen with surgical intervention.

In short and long-term studies, the clinical benefit of ESWT for plantar fasciitis across the dimensions of pain, function, patient satisfaction and activity has been consistently positive.

The results of this study combined with the results that have been reported in the world literature over the past five years are significant and greater in number than similar studies evaluating surgery for plantar fasciitis. The results seem to be equivalent, with faster recovery and no complications from ESWT.

It is our opinion that ESWT can no longer be considered as an investigational treatment and should be made compensable by insurance to the public at large.

We are aware of the limitation of this study because of the limited number of responses (75, 38.1%) drawn from our index number of (197)

References

Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. Nov 2008;36(11):2100-9.
Lowell Scott Weil Jr. DPM, Thomas S. Roukis DPM, Lowell Scott Weil Sr. DPM, and Anthony H. Borrelli DPM, Extracorporeal shock wave therapy for the treatment of chronic plantar fasciitis: indications, protocol, intermediate results, and a comparison of results to plantar fasciotomy. Journal of Foot and Ankle Surgery. 41(3): 166-72.
Ogden, John A, MD, et al. Electrohydraulic High-Energy Shockwave Treatment for Chronic Plantar Fasciitis. The Journal of Bone and Joint Surgery (American) 86:2216- 2228 (2004)
Wang, Chin-Jeng, MD, et al. Long-Term Results of Extracorporeal Shockwave Treatment for Plantar Fasciitis. The American Journal of Sports Medicine. April 2006. 34: 592-596.
Benton-Weil, W, Weil, Jr, LS, Weil, Sr, LS, Borrelli AH, Percutaneous plantar fasciotomy, :a minimally invasive procedure for recalcitrant plantar fasciitis. J. Foot Ankle Surg. 37(4):269-272, 1998

View as Powerpoint

(847) 390-7666

Email : info@weil4feet.com

Website : www.weil4feet.com

Retrospective Comparison of Patients Undergoing Formal Physical Therapy Versus No Physical Therapy Following Bunion Correction

2010-02-24T09:32:00.000-06:00

Retrospective Comparison of Patients Undergoing Formal Physical Therapy

Versus No Physical Therapy Following Bunion Correction

Kelly A. Malinoski, DPM, Lowell Weil Jr., DPM, Lowell Scott Weil, Sr., DPM

Anthony Borrelli, DPM, Wendy Benton-Weil, DPM

WEIL FOOT AND ANKLE INSTITUTE, DES PLAINES, IL www.weil4feet.com

Introduction

Physical therapy (PT), following bunion correction, is theorized to recover range of motion of the first metatarso-phalangeal joint (MTP). PT can also aid in decreasing the recovery period from hallux valgus surgery, which is particularly advantageous to the active patient.1 Physical therapists frequently use manual therapy procedures as part of comprehensive rehabilitation programs to help patients regain joint mobility and function.2

Few investigations include both subjective and objective measurements of the effectiveness of physical therapy treatments in reconstructive foot surgery, particularly following hallux valgus correction.

We hypothesize that patients receiving formal physical therapy will yield functional benefits and an improved return of 1st MTP range of motion, as well as an increased patient satisfaction as compared to those who did not receive a formal physical therapy program, post operatively. This study evaluates the effectiveness and differentiates whether a regimented course of physical therapy following bunion correction enhances the results of the surgical correction.

Methods

Study Design

Patients with a history of receiving Scarf bunionectomies by three surgeons at the Weil Foot & Ankle Institute were identified using retrospective chart review and (N=55) recruited to participate in this retrospective, post-operative follow-up study. All three surgeons used virtually the same technique in performing the Scarf Bunion Procedure.

Two of the surgeons used a standard, formal physical therapy program beginning at one week post-operative. The third surgeon did not use physical therapy post operatively.

Data Collection

Patients were administered five subjective instruments during their follow-up clinical office visit. Instruments were completed before any clinical assessment to avoid biasing patient’s responses. Several instruments include objective clinician rating, which were completed during the course of the office visit. Retrospective chart review was used to obtain pre-operative pain ratings as well as the number of post operative physical therapy sessions attended.

Instrumentation

The 8-item American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale: a patient-reported measure of pain combined with a clinician rating of function and alignment.
The 3-item AOFAS Hallux MPJ Scale: a patient-reported measure of pain and function.
The 10-item Weil Satisfaction Survey: a newly developed patient-reported measure of function, pain, patient satisfaction, level of improvement and time necessary to resume regular activities.
The 5-item American College of Foot and Ankle Surgery First Metatarsophalangeal Joint and First Ray: a patient-reported measure of pain, cosmesis, and functional capacities with clinician ratings of radiography and function.
The 23-item Foot Function Index: a patient-reported visual analog scale (VAS) of pain severity, activity difficulty, and limitation frequency.

Statistical Analysis

Descriptive statistics were used to examine the distribution for all key variables. For categorical variables (i.e., level of satisfaction, level of function, and etc..), frequency counts were calculated. For continuous variables (i.e., level of improvement, level of pain), measures of central tendency and dispersion were calculated. Change in level of pain was assessed using a paired samples t-test. The sub-analyses by physical therapy participation was assessed using Independent Samples t-test. Additional analyses included cross tabulation and correlations of key variables to further understand the data. SAS version 9.1 was used for all analyses.

Overall Results

Patient Demographics

The study included 55 patients (79 feet; average age 57, range 16-78 years) with right (n=16), left (n=15), or bilateral (n=24) Scarf Bunionectomies. 44 patients (80.0%; 65 feet) participated in a formal, regimented physical therapy program and 11 (20%; 14 feet) were not given a post operative, PT program.

Patient Satisfaction

48 out of 55 patients (87.3%) were moderately to extremely satisfied with the results of the Scarf Bunionectomy procedure.

Function and Daily Activities

49 out of 55 patients (89.1%) were able to return to their routine daily activities at an average of 11.6 weeks (SD=10.2, range=1-48 weeks). 48 out of 55 patients (87.3%) reported similar or improved post-operative functioning. On the AOFAS Hallux MPJ, 89.4% of patients indicated “no limitations” in daily activities.

Pain

Patients reported a 87.1% (SD=21.8) improvement in pain post-operatively. There was a significant reduction in patient reported pain rating (t=6.280, df=30, p= < 0.0001). The average change in pain rating (0-10) was a 3.2 point decline (FIGURE 1: SD=2.9). Pre-operatively, patients reported an average pain score (0-10) of 5.3 (SD=2.3, range=2-10). Post-operatively, patients reported an average pain score (0-10) of 2.1 (SD=2.1, range 0-4). On the patient report AOFAS Hallux MPJ, 75% of patients indicated “none” to “mild, occasional” pain.

Physical Therapy Results

Results indicate that patients who participated in physical therapy reported significantly higher foot function and fewer activity limitations as measured by the Foot Function Index (see Table 1: Foot Function Index), than the patients who had no physical therapy program. These results were confirmed by the patient reported measure of functional capacity as well as the clinical (objective) rating of foot function on the ACFAS (SEE TABLE 1: ACFAS).

Dorsiflexion was categorically measured on the ACFAS as well as clinically rated during the office visit. For 65.0% of patients who participated in physical therapy, the range of motion was 60 degrees or greater (39 feet, mean=66.4, SD=20.2). Only 45.5% of patients who did not participate in physical therapy had a similar range of motion (5 feet, mean=60.7, SD=25.8).

Plantarflexion was categorically measured on the ACFAS. For 98.4% of patients who participated in physical therapy, the range of motion was 0 degrees or greater (63 feet). The same was true for 91.7% of patients who did not participate in physical therapy (11 feet).

Conclusions

The application of continuous passive motion to joints immediately after joint surgery stimulates the regeneration of articular tissue, eliminates adhesions, prevents joint stiffness, reduces pain, and is well tolerated by patients.³
Although the idea of post-operative physical therapy is supported and recommended by podiatric and orthopedic surgeons, the literature is weak in identifying the benefit of physical therapy after reconstructive bunion correction.

Patients who underwent regimented physical therapy post-Scarf Bunionectomies at the Weil Foot & Ankle Institute presented higher satisfaction rates, and scored better in the Foot Function Index and ACFAS total scores, versus those patients who did not complete physical therapy. These patients were also shown to function better and at a higher level of capacity with less limitation (TABLE 1). It is imperative to note that the correlation, while positive, between AOFAS and ACFAS scores is considered marginally moderate (r=0.409). Similarly, it was expected that the correlation between the Foot Function Index and ACFAS and AOFAS would be low, but the direction negative, given that one is patient-reported while the other two are clinically rated. This assumption was true for the ACFAS (r=-0.072); however, for the AOFAS, the correlation was positive (r=0.007). This indicates that the ACFAS may be more sensitive for discriminating between patient groups in observational studies.

Formal physical therapy following bunion correction yields favorable clinical and functional results, including an increased level of patient satisfaction, and is shown to provide continual long-term benefits after the post-operative course.

References

Saxena, A., O’Brien, T. Postoperative Physical Therapy for Podiatric Surgery. JAPMA. 1992, Aug. 8. 2(8): 417-23.
Deyle, Gail D., MPT et al. Effectiveness of Manual Physical Therapy and Exercise of the Knee:
A Randomized, Controlled Trial. Annals of Internal Medicine. Vol. 132 (3), 1 Feb. 2000. 173-8.
The Podiatric Application of Continuous Passive Motion: A Preliminary Report. JAPMA
Dec. 1991; 81(12): 631-7.

View as Powerpoint

(847) 390-7666

Email : info@weil4feet.com

Website : www.weil4feet.com

Correction of 2nd MTP Instability Utilizing a Weil Osteotomy and Dorsal Approach Plantar Plate Repair – A New Technique & Early Results

2010-02-23T15:14:00.003-06:00

Correction of 2nd MTP Instability Utilizing a Weil Osteotomy and Dorsal

Approach Plantar Plate Repair – A New Technique & Early Results

Kelly A. Malinoski, DPM, Lowell Weil Jr., DPM, Lowell Scott Weil, Sr., DPM

WEIL FOOT AND ANKLE INSTITUTE, DES PLAINES, IL www.weil4feet.com

Introduction

The plantar plate is the principal sagittal plane stabilizer of the metatarsal-phalangeal joint (MTP) and any compromise to the integrity of the plate can lead to wearing and rupture of this joint. Plantar plate tears often contribute to metatarsalgia, leading to chronic instability, subluxations, and dislocations. A plantar plate rupture can be either acute, due to a hyperextension injury, or chronic in nature, secondary to chronic metatarsal overload. Primary repair of a plantar plate tear has been performed for years, although the etiology of a non-traumatic, isolated primary plantar plate injury has not been clearly understood.1,2,3 The traditional repair of the plate from a plantar approach is both difficult and does not address the underlying etiology of those cases caused by chronic pathology: an elongated or sub-located lesser metatarsal.

We present a new technique and early results that incorporate a Weil Metatarsal Osteotomy and primary repair of the plantar plate through a DORSAL approach. We have utilized this technique for over two years with promising early results. This unique surgical technique addresses and allows for correction of both the metatarsal deformity and plantar plate pathology through one, minimally invasive, surgical approach.

Surgical Technique

A curvi-linear incision is made overlying the 2nd MTPJ exposing the metatarsal head and base of the proximal phalanx.
A Weil metatarsal osteotomy is performed and the capital fragment is retrograded under the distal one third of the metatarsal, and is held in temporary position with a smooth .045 wire. This allows for exposure to the plantar plate and flexor tendon, when visible. The redundant dorsal bone surface is resected about 3-4 mm and smoothed to normal anatomical contour (FIG. 3).
The plantar plate is visualized and noted to be torn (in this case) and/or attenuated (in other cases) at the insertion in the base of the proximal phalanx. The plantar plate is fully mobilized distally and freed of any residual attachments. (FIG. 4).
Using the Smart Stitch System*, #2 Magnum wire is used to grab and fixate the plantar plate proximally with a mattress suture (FIG. 5, 6, 7).
Two drill holes are then made with .062 threaded k-wires in the base of the proximal phalanx; one dorsal-medial to central and the other dorsal-lateral to central (FIG. 8). Using monofilament wire through the bone tunnels, the sutures securing the plantar plate are passed from the plantar to the dorsal surface of the base of the proximal phalanx.
The temporary pin fixating the Weil osteotomy is removed and the 2nd metatarsal head is reduced, properly aligned to create corrected positioning and fixated with a 2.4mm threaded head screw or two .062 threaded k-wires (FIG. 9, 11).
The suture on the dorsal surface of the proximal phalanx is now tied dorsally with the digit held in plantarflexion, and the 2nd MTP is reduced and stabilized
(FIG. 10, 11, 12).

*Arthrocare Opus

Function and Daily Activities

11 out of 13 patients (84.6%) reported similar or improved post-operative functioning. All patients were able to return to their routine daily activities at an average of 14.7 weeks (SD=7.4, range=4-24 weeks).

Pain

Patients reported a 71.9% (SD=36.4) improvement in pain post-operatively. There was a significant reduction in patient report pain rating (t=6.824, df=13, p=< 0.0001). The average change in pain rating (0-10) was a 4.9 point decline (SD=2.7, range 2-8 reduction). Pre-operatively, patients reported an average pain score (0-10) of 6.7 (SD=1.7, range=2-9). Post-operatively, patients reported an average pain score (0-10) of 1.6 (SD=1.4, range 0-4).

Conclusions

Metatarsophalangeal joint instability/dislocation can be a very difficult problem for patients and surgeons. Until recently, repair of the plantar plate was limited to soft tissue correction without addressing the bony etiology of the deformity.

Through a dorsal approach, a Weil Osteotomy is performed and the plantar plate tear is visualized and primarily repaired, advanced, and strongly anchored into bone using a shoulder arthroscopy knotless system, addressing and correcting the true etiology of plantar plate pathology.

Despite the small sample size, this procedure has been shown to yield consistent and favorable early results across the domains of patient satisfaction, pain, function and daily activities, as well as ACFAS & AOFAS Scoring Scales

References

R.B. Johnston III, J. Smith and T. Daniels, The plantar plate of the lesser toes: an anatomical study in human cadavers, Foot Ankle Int 15 (1994), pp. 276–282.
Blitz, DPM, et al. Plantar Plate Repair of the Second Metatarsal Phalangeal Joint: Technique and Tips. Journal of Foot & Ankle Surgery. Vol. 43, Issue 4. 266-270.
Bouché DPM, FACFAS, Heit DPM, FACFAS Combined Plantar Plate and Hammertoe Repair with Flexor Digitorum Longus Tendon Transfer for Chronic, Severe, Saggital Plane Instability of the Lesser MPJ’s: Preliminary Observations. Journal of Foot & Ankle Surgery. Vol. 47, Issue 2, 2008. 125-37.

View as Powerpoint

(847) 390-7666

Email : info@weil4feet.com

Website : www.weil4feet.com

Treating a Fracture with Positive Results

2010-01-26T09:47:00.001-06:00

I had surgery with Dr. Weil on November 16, 2009 to fix a bad fracture with tissue and nerve damage on my right foot. I already had surgery with another doctor a year before at Northwestern Hospital and my foot was becoming deformed and I was in a lot of pain. Well my surgery with Dr. Weil, Sr. was very successful and after 8 weeks I no longer have any doctor appointments. One thing I think made my surgery a success is I listened to him after each appointment. Dr. Weil stressed to me to keep weight off and always wear the boot when walking and use the machine called Vital Wrap to ice the foot. Well I wore the boot 24/7 except going to bed and taking a shower. Vital Wrap is wonderful for instant relief. Listening to the doctor and taking it seriously by not walking on the foot too soon made the difference. My post x-rays showed the healing and after sometime the swollen will go down. My only advice is to listen to the doctor, take his directions seriously and you will have success. Don't work out too early, it will come soon enough. The other note I would like to say is Dr. Weil is a specialist for feet, not hip replacements, knee replacements, etc. Also his stafff is the best I have ever seen and his nurse, Pam is such a huge asset for Dr. Weil.

Sue
Des Plaines, IL

Treating Heel Pain with ESWT: Our Happy Patients

2009-11-10T13:27:00.002-06:00

Hey Doc! I am writing to let you know of my ESWT and office visits from start to finish. When I got there on my first visit I liked the fact that you were straight forward and didn’t try to sell me ESWT and let me know it was not a covered (insurance) item. I had just gotten a shot from my referring doctor so my foot was feeling good. You introduced me to Jennifer and said when and if I decide to do something please call her and she will take care of it from start to finish. She did.

I called several months later and came in and got my first treatment followed by the 3 other two a few weeks apart and we talked every time and I did feel like you were really listening and wanted to let you know I appreciated that. Still and all my foot was not feeling as good as I would have liked. Once again you took the time to listen and we talked about a moving forward game plan. From here is where I really to emphasize my treatment by your staff; in particular Jennifer (She was great!!). The plan was to send in for insurance approval for orthotics. Jen had me get molded so that if they approved them then you get them done and I could come back when complete and be good to go. She said if they say no, we will go to Plan “B” which was using my fourth “freebie” ESWT, and then see how that took and go from there to Plan “C”, which was surgery.

I was called the next day by someone and told that insurance wouldn’t cover the ortoics and if I wanted I would have to pay $550 now. I said to hold them and I will think more on them and get back with them. Then I asked to speak to Jen and schedule the fourth ESWT treatment. I really thought this would be a hassle or was thinking something would be less than before being on you. It was not and you handled it just like normal and one of the things I want to report in this letter is the fourth time was the charm and my foot has felt 100% better since.

Everything seemed great until…I got a bill wanting me to pay approx. $125 for my part of the bill for work that was never done and what the insurance didn’t cover on the orthotics that they did pay for. I called and talked to someone who I’m sure was more than happy to hand this over to Jen to take care of. (I was not happy) The first thing Jen said was will take off everything on this bill that’s not right and make everything right.

She had me come in for another fitting which did not have the office co-pay since I was there before for that. (A cheap guy like me appreciates that). Made the next appointment for the fitting and said if I had any issues on the bill we will finalize them after the fitting. Today after the fitting she walked me out to the waiting area, spoke to Lindsay personally and had her correct the bill to what made sense and then had Lindsay (who was also very nice) go over the bill with me in detail. Then Jen stopped back in and made sure I was a “happy camper”. This was the right thing to do, the professional thing to do, and the nice thing to do. They took a wrong and made it right. Please accept my compliments on your work, Lindsay’s work, and especially Jennifer’s work. She is the best! Please feel free to share this and use me for any reference.

Thanks,
Bob
Franklin Park, IL

Teamwork to Treat Complex Cases: a Patient Testimonial

2009-11-10T13:24:00.002-06:00

Dear Dr. Baker and Dr. Bongiovanni,

I would like to sincerely thank the both of you for your service and dedication put forth in the healing of my foot. I would not be where I am today without your expertise, guidance, and diligent care.

I had back surgery as an infant, which resulted in neuropathy in my foot and three toe amputations and countless infections. When I first came to your office back in August, I was quite frustrated with the medical care (or lack thereof) that I’d been receiving. My problems were recurring, and I felt as though I was getting nowhere, or even going backwards. I searched locally for another doctor for a second opinion, and was repeatedly told that the doctors didn’t see patients with a condition like mine. I originally found out about Weil Foot & Ankle Center by doing some online research on a Saturday morning, reading about Charcot. When I dug a little further, I realized that your offices were in Illinois thus I immediately picked up the phone to call to make an appointment. I cannot explain the excitement that I felt going to get another opinion in such a well-regarded establishment.

I have only wonderful things to say about Dr. Baker and Dr. Bongiovanni. They have both been a true testament of what a doctor should be: honest, caring, practical, down-to-earth, and just plain nice! I have felt comfortable around the both of them and respect their immense knowledge of properly caring for the foot. They both were not only concerned with treating the existing problem but finding ways of prevention to avoid future problems. They took the time to ask me questions about my lifestyle and gave me practical solutions that fit appropriately. They did not just come in, look at my foot, offer a few phrases and leave; they spent on average 20-25 minutes each visit to talk about what was presently at hand.

Since then, I have visited your office on several occasions. All of the staff are so kind and really put forth the extra effort to accommodate me. I live about 75 miles away, and each visit was scheduled to see both of my doctors within a short time period to save on having to make two trips.

I would like to sincerely thank Dr. Baker , Dr. Bongiovanni, all the nurses and staff for the exemplary care I that I received. I would highly recommend Weil Foot & Ankle Center to anyone looking for a physician. Thank you again.

Cordially,

Kate
Wauwatosa, WI

A Successful Bilateral Scarf Procedure

2009-11-10T13:20:00.001-06:00

Hi, Dr. Weil,

I know you're busy, so I'll try to make this brief...

My name is Trip Swindell (Major Swindell), and you performed a bilateral scarf on me in 2001 (I was the patient with hypermobility, or "double-jointedness").

I live in Houston, now, and just yesterday, I had to choose a local podiatrist to extract a shard of glass from my foot. It just so happened that I was seen by Dr. Michael Mineo, who was amazed by your work and the range of post-surgical mobility I have. He told me that he's known you for many years, and his son is currently gaining internship experience as a volunteer in your office.
He went further to tell me that you are the top podiatry surgeon in the country... perhaps the world!

What a small world, huh?!

Thank you for everything you've done to make my life what it is today... I'm completely pain-free and more physically active than I've ever been.

Trip Swindell
Houston, TX

Relieving Heel Pain with Orthotics and the Arizona Brace

2009-11-10T13:16:00.001-06:00

Dear Dr. Bongiovanni: (or as known in my office "Dr. BonJovi")

I thought I would drop you an email to give you an update on my progress with my new orthotics and Arizona brace.

Honestly, I was a little apprehensive when I left your office with my new devices. They initially felt obtrusive and uncomfortable. Within an hour I felt very secure and comfortable in the Arizona brace and actually left it on all day. (as you suspected I went all out!)

I have worn it every day with the exception of the last two days because I was in Phoenix for a night and wore shorts and topsiders. Even being without it my left ankle and foot felt much better, better than they have in years. I still have slight heel pain but much less than before. I cannot tell you how liberating the feeling is. I have seen over three different Podiatrists and Orthopedic Surgeons and nobody was able to give me the level of relief that you and Dr. Weil have given me. I would just like to express my deepest gratitude to you. Your help is so greatly appreciated.

Thank you for your honesty and professionalism and more importantly, your talent! You should be very proud. You guys are awesome.

Sincerely,

Dr. James Kakos
one happy patient!!!:-)

My Weight Loss Success Story - 172 pounds lighter!

2009-09-15T09:38:00.007-05:00

I was always on the heavier side once I graduated from High School and was on my own. I really never paid attention to my weight just figuring I had the rest of my life to get healthy. So why do anything about it right now when I can just enjoy myself.

In January of 2007 I had surgery on my right ankle by Dr. Weil, Jr because I wasn’t stable when I walked and I would sometimes fall. Dr Weil told me that one of the reasons I am having so much of a problem was because of the extreme amount I weighed and the pressure that weight placed on the ankle. He said losing weight would help.

I saw my General Practitioner and she did blood work for cholesterol and took my blood pressure, and heart rate. My cholesterol was off the charts at a whopping 386, my blood pressure was 189/99 and my resting heart rate was 112. She was very worried about me, told me losing weight would help me increase my overall health.

I decided that enough was enough and to get going on a weight loss program. When I weighed in I just cried when the scale read 404 pounds!

I set my goals small because I didn’t want to think of the larger picture. My sights were set on losing 5 lbs at a time, then my first 10%. I followed the plan, began exercising and the weight started to fall off; before I knew it I lost 100 lbs by Christmas of 2007!

My biggest focus was to become healthier and fit for the rest of my life now and not later when it would be harder to do. I wanted to live an active, fun, healthy life and not have my weight hold me back from doing anything.

I went back to the doctor in March of 2008 to be re-tested and my doctor was shocked by my new look! When the tests came back, my cholesterol had dropped 240 points to 146, my blood pressure went down to 112/78 and my resting heart rate is at an average of 38!

Now I am able to walk almost 6 miles a day, feel fit and really feel great about how I look. And my friends and co-workers are seeing me as the inspiration to lose weight and get healthier for themselves.

Total inches lost since I started in Feb of 2007:

Waist – 33 inches

Hips – 27 inches

Chest – 19 inches

I have gone from a size 6x to a 16 in tops/blouses!

I have gone from a size 32 to a 14 in pants/jeans!

I have gone from a size 34 to a 12 in a swim suit!

The most important thing I am proud of is the hard work that I have done to make sure that I never see myself be at where I was in weight ever again.

My thanks goes to all the people that have helped me along the way from personal trainers ( Cindy Huber) my weight loss leaders, Dr. Weil Jr., Dr. David, family, friends and the 110% of support from my husband Brian without whom I couldn't have done this!

TOTAL WEIGHT LOST SINCE FEBRUARY 2007 172 pounds!!!

Sincerely,

Heather
Mount Prospect, IL

Save Your Soles: A Guide to Foot Pain

2009-05-28T08:10:00.001-05:00

Treat your feet right and they'll return the favor. Our experts reveal ways to kick the bad habits that can lead to serious foot pain.

By Dorothy Foltz-Gray

Preventing and Soothing Problems

Maybe you were born with problem feet -- feet that turn in or out, arches that are too high or too low. Or you're dealing with foot pain that's self-inflicted, caused by tight shoes or high heels. Whatever the cause, foot pain is overwhelmingly a female problem: Experts say that 80 percent of foot surgery is performed on women. Foot doctors frown on teetery slingbacks, backless sandals and sky-high heels -- a disappointment for anyone who's ever coveted sexy stilettos or loves to lounge in flip-flops. If a shoe isn't supportive or fits poorly , say podiatrists, it's best not to wear it. Easier said than done, we know, but to avoid developing a foot problem or making one you already have worse, resist heels higher than 2 inches -- at least most of the time -- and tight squeezes (there should be about half an inch of space between your longest toe and the tip of the shoe).

"Try several sizes whenever you buy shoes," says Leslie Campbell, DPM, a foot and ankle surgeon at Presbyterian Hospital, in Allen, Texas. "Feet can change a half size in length, and also in width, at any time during adulthood -- from age, weight gain or loss, or pregnancy. And buy in the afternoon when feet tend to be the most swollen." Even if your feet mostly feel fine, our guide will help you pinpoint potential problem areas so you can stop bad habits that could lead to future foot trouble. If it's too late for preventive measures, you'll find the latest ways to soothe sore toes, heels, and soles

Pain Problem: Achilles Tendinitis

What It Is: Inflammation of the Achilles tendon (heel cord), causing pain and swelling at the back of your heel and ankle.

Cause: Some people are born with shortened muscles and tendons. But many women get what's called adaptive Achilles tendinitis by wearing high heels all day long -- which shortens those muscles and tendons -- and then going barefoot at night, making them suddenly lengthen. "Such shifts stress the Achilles tendon, which leads to inflammation," says Dr. Campbell.

Foot Fix: A heel insert can lift and cushion your heel, relieving tension on the tendon. An ice pack several times a day and over-the-counter anti-inflammatories such as ibuprofen can help reduce swelling. Extracorporeal shock wave therapy, which uses sound waves, may help. And try this stretch several times a day: Stand with both feet on the same staircase step, holding the banister. Let one heel drop below step edge; hold for 30 seconds. Do on other foot. Repeat three to four times.

Pain Problem: Plantar Fasciitis

What It Is: An inflammation of the plantar fascia, the tough band of tissue that runs along the bottom of your foot between the heel bone and the base of your toes. It's one of the most common causes of foot pain and can make you feel as if you're walking on a knife, especially in the morning (the fascia tightens overnight).

Cause: Feet over-pronate, stressing the plantar fasciae. Open-backed or flimsy shoes can strain the area. So can weight gain, which may thin the fat pad beneath the heel, flattening the arch and straining the bottom of the foot. Dancers, runners, and people who stand a lot often develop this problem.

Foot Fix: Add cushioned insoles or heel pads to supportive shoes with a 1- to 2-inch heel or use custom-made orthotics. Over-the-counter anti-inflammatories, such as ibuprofen and naproxen, and cortisone injections may also help. Other approaches your doctor may suggest include extracorporeal shock wave therapy. There's also radiofrequency therapy -- electrical signals are sent through a probe inserted through small punctures in the heel area -- which is more likely to be covered by insurance, says Chicago-area podiatric surgeon Lowell Weil, Jr., DPM. Another option is surgery on the fascia itself. Stretching in the morning, evening, and before exercise also helps. Try this: Stand arm's length from a wall, one foot behind the other, legs straight, heels on the floor. Place your hands on the wall and lean in, stretching the calf muscles. Do 10 repetitions; switch legs and repeat.

Pain Problem: Corns and Calluses

What They Are: Corns are balls of thickened skin, usually on the tops, sides, or tips of your toes; calluses are rough, thickened patches of skin on the heels and soles of the feet.

Cause: When your shoes pinch and press on your feet, your skin reacts to the friction and pressure by getting thicker.

Foot Fix: A podiatrist can shave the dead cells from the corns and calluses and prescribe an exfoliating cream. You can also reduce skin buildup by rubbing a corn or callus daily with a pumice stone or using a foot file. Silicone pads sold in drugstores protect the areas from pressure. Acid-based corn and callus removers do work, but Dr. Campbell points out they may burn your skin.

Pain Problem: Neuroma

What It Is: A benign growth, usually between the third and fourth toes, that pinches your nerves -- causing swelling and pain between the toes and a burning sensation in the ball of your foot.

Cause: When the foot's long bones are unusually mobile and the heads of these bones lie close together at the base of the toes, they may squeeze the nerve, creating a benign growth. Both wearing high-heeled pointed-toe shoes and going barefoot can aggravate the condition.

Foot Fix: Injections of cortisone, over-the-counter or prescription anti-inflammatory pills, orthotics, and stable, roomy low-heeled shoes can all help. Or your doctor may remove the growth or use cryotreatment (a cold probe that inactivates the nerve) or surgery that releases the ligament that's compressing the nerve.

Pain Problem: Athlete's Foot and Toenail Infections

What They Are: Fungal infections of the skin or nail bed. Athlete's foot can make the skin between the toes itchy and blistered. Fungal toenail infections (nails turn thick, yellow, and brittle) are more unsightly than uncomfortable.

Cause: "Fungi are everywhere," says Deerfield Beach, Florida, podiatrist Cary M. Zinkin, DPM. Going sockless in closed shoes or barefoot at the gym ups your chance of getting a fungal infection. So does having a pedicure with unsterilized instruments.

Foot Fix: For athlete's foot, your doctor may prescribe antifungal cream. For fungal toenails, she may prescribe a paint-on medication or three months of Lamisil pills, unless you have liver or kidney problems. Also ask about Vicks VapoRub-type products. "To avoid infections, keep your feet dry and clean," says Dr. Zinkin. "Dry between your toes after you shower and then use a foot powder." Wear clean cotton socks -- not nylon socks or tights -- to make feet less welcoming to fungi. And if you get pedicures, be sure both the instruments used and the footbath you soak in have been sterilized.

Pain Problem: Hammertoes

What It Is: A condition in which one or more toes become so bent at the joint that it can look like an upside-down V. Hammertoes also cause swelling and corns -- thickened skin -- on the top of the toes, which can restrict the joint's movement.

Cause: Heredity -- but also high heels, says Dr. Campbell. "More than half of my female patients have hammertoes." Wearing unstable shoes, such as stilettos and flip-flops, can contribute to the problem by providing so little support for your foot that you bend your toes when you walk, grabbing the shoe bed for balance. Eventually you may be unable to straighten one or more of your toes.

Foot Fix: Although only surgery can straighten bent toes, there are ways to ease the pain and keep hammertoes from becoming worse. Your doctor can shave the corns and prescribe exfoliating cream to help normal skin resurface. She may prescribe an orthotic to stabilize your foot and will certainly tell you to trade your high heels for low-heeled shoes that will keep your feet from wobbling. You can also buy over-the-counter silicone pads that slip between or over the toes to reduce friction and pressure from your shoes. And try using an ice pack to reduce painful inflammation of the toes, which should help make your shoes fit better.

Originally published in Ladies' Home Journal, June 2009.

White Sox Won't Rush Quentin Back

2009-05-27T08:41:00.001-05:00

By Scott Merkin / MLB.com

05/26/09 10:50 PM ET

ANAHEIM -- Carlos Quentin is the type of player who never wants to leave the lineup, doing whatever he possibly can to keep himself in play.

Over the past couple of weeks, that particular desire pushed the White Sox All-Star left fielder to play through pain in his left foot. But the team now has come to a point where a trip to the disabled list might be the best solution involved for the intensely driven Quentin.

"If we need to put him on the disabled list, we will do it," said White Sox manager Ozzie Guillen prior to Tuesday's game at Angel Stadium. "We will need him in the stretch, but we have to wait to see what happens.

"He might try to play through soreness or pain just to be on the field. That don't work because the more pain you have, the more days you are going to lose."

Quentin basically has lost the remainder of the White Sox six-game road trip due to a recurrence of the injury on Monday night. Quentin launched a double to center during the three-run first in the team's 17-3 victory, but he pulled up lame as he made the turn at first. Quentin said that he felt a pop and was quickly replaced at second by Brian Anderson.

Anderson, who knocked out three hits in place of Quentin on Monday, was back in center on Tuesday, with Scott Podsednik playing left field. Quentin was sent back to Chicago to be examined by White Sox team doctors, including podiatrist Lowell Scott Weil.

The plan is for Quentin to rejoin the team in Chicago on Monday, when the White Sox begin June with a 12-game homestand, including five against first-place Detroit. At that point, Guillen plans to sit with Quentin and general manager Ken Williams to discuss if Quentin's bout with planter fasciitis has improved enough for him to retake his starting post or if he will be inactive for another week to 10 days on the DL.

"After Monday, we want him to say where he is and then we make the decisions," Guillen said. "How bad is it? It's too early to say how he's going to be or how he's going to react. I think Carlos was playing without being ready. That's my thought. He no was ready and just wanted to be on the field and it got a little bit worse. I have to sit down with him and Kenny and make sure he's honest with us. We don't need a hero."

Guillen added that Quentin was walking a little better on Tuesday than White Sox athletic trainer Herm Schneider thought he would. Quentin, who missed a game on May 12 and was out from May 16-20 with the same injury, is hitting .229 with eight home runs and 20 RBIs. But seven of those long balls came during the white Sox first 12 games.

Scott Merkin is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.

International Society for Medical Shockwave Treatment

2009-04-15T07:23:00.005-05:00

Dr. Lowell Weil, Jr.

Lowell Weil, Jr., DPM, MBA was elected President of the International Society for Medical Shockwave Treatment (ISMST) at their annual meeting in Sorrento, Italy, this past week. He is the first podiatric physician to be elected to an executive position of this organization. His term of office will run through June of 2010 when he will host the 13th Annual ISMST2010 Meeting in Chicago, IL. This multidisciplinary meeting will not only involve ESWT for musculoskeletal disorders, but also the application of this modality in the treatment of wounds, arterial disorders, cellulite, and other cosmetic conditions. Dr. Lowell Weil, Jr.

Dr. Weil, Jr has pioneered the use of extracorporeal shockwave treatment ( ESWT) for plantar fasciitis in the United States and has been involved in three FDA studies and written several papers, as well as co-authored a book on the subject of musculoskeletal ESWT. Dr. Weil, Jr. is the Fellowship Director of the Weil Foot & Ankle Institute, Des Plaines, IL and is a team podiatrist for the Chicago White Sox.

Highland Park Office

2009-02-26T15:42:00.007-06:00

Weil Foot & Ankle Institute

is pleased to announce we have moved our

Highland Park office to a new location.

We are now located in downtown

Highland Park

1729 Green Bay Road (just south of Central Avenue)

Our new location is open 6 days a weeks to better serve our patients.

Chicago Fire Soccer

2009-01-25T18:15:00.006-06:00

Lowell Weil, Jr., DPM, MBA, FACFAS has been named the Associate Team Physician for the Chicago Fire soccer team.

Happy New Year

2009-01-09T09:18:00.000-06:00

Happy New Year from California

I wanted to join all of your other grateful patients, in wishing you a most
wonderful New Year. My sincere hope is that your year is filled with good
health and happiness.

You greatly improved my quality of life when you operated on my left foot
for my metatarsalgia on the 4th of August. The pain is gone, and for that you
have my deepest appreciation.

Again, Happy New Year to you and your loved ones.
Sincerely, Ivan Rowan M.D.

Shockwave Treatment for Achilles Tendinopathy

2008-12-22T16:00:00.002-06:00

Eccentric Loading Versus Eccentric Loading Plus Shock-Wave Treatment for Midportion Achilles Tendinopathy:

A Randomized Controlled Trial

Jan D. Rompe, MD1*, John Furia, MD2, Nicola Maffulli, MD, PhD, FRCS(Orth)3
1 OrthoTrauma Evaluation Center
2 Sun Orthopaedics Group
3 Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine

Abstract

Background: Results of a previous randomized controlled trial have shown comparable effectiveness of a standardized eccentric loading training and of repetitive low-energy shock-wave treatment (SWT) in patients suffering from chronic midportion Achilles tendinopathy. No randomized controlled trials have tested whether a combined approach might lead to even better results.

Purpose: To compare the effectiveness of 2 management strategies—group 1: eccentric loading and group 2: eccentric loading plus repetitive low-energy shock-wave therapy.

Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Sixty-eight patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on an intention-to-treat basis.

Results: At 4 months from baseline, the VISA-A score increased in both groups, from 50 to 73 points in group 1 (eccentric loading) and from 51 to 87 points in group 2 (eccentric loading plus shock-wave treatment). Pain rating decreased in both groups, from 7 to 4 points in group 1 and from 7 to 2 points in group 2. Nineteen of 34 patients in group 1 (56%) and 28 of 34 patients in group 2 (82%) reported a Likert scale of 1 or 2 points ("completely recovered" or "much improved"). For all outcome measures, groups 1 and 2 differed significantly in favor of the combined approach at the 4-month follow-up. At 1 year from baseline, there was no difference any longer, with 15 failed patients of group 1 opting for having the combined therapy as cross-over and with 6 failed patients of group 2 having undergone surgery.

Conclusion: At 4-month follow-up, eccentric loading alone was less effective when compared with a combination of eccentric loading and repetitive low-energy shock-wave treatment.

Heel Pain

2008-12-09T12:34:00.004-06:00

Severe recalcitrant heel pain, resulting from repetitive trauma to the plantar fascia, is a commonly observed phenomenon. Although this condition is frequently referred to as ‘heel spurs’ and plantar fasciitis (acute inflammatory stage) and plantar fasciosis (chronic degeneration) are currently accepted as the more accurate terms. Symptoms most often occur during the first few steps in the morning but may also be effected during intense activity or with prolonged standing. The source of pain symptoms, which are usually perceived as a gradual onset of burning, is located at the origin of the plantar fascia at the calcaneous (heel bone). Risk factors such as low or high arches or over-pronation of the foot, gastrocnemius equines (tight calf muscle), systemic disease, or obesity may exacerbate pain.

The plantar fascia, or aponeurosis, is a multi-layered fibrous structure consisting three discreet sections: medial, central, and lateral. The plantar fascia fans out distally from the mid-portion of the heel and connects to the five digits of the foot. The function of the plantar fascia is to provide support to the arch of the foot and stability to the joint in the largest toe, where most weight bearing occurs during the heel rise phase of walking. The cause of the pain mechanism in recalcitrant plantar fasciitis is not yet clear, but is believed to be associated with a degenerative response linked to chronic overuse. On magnetic resonance imaging (MRI), acute plantar fasciitis exhibits microtears in the fascia and concomitant signs of acute inflammation such as marked thickening of the insertion of the plantar fascia, edema at the fascia-muscle and fascia-fat interfaces, and inflammation of the adjacent subcutaneous fat. Over time, unresolved recalcitrant plantar fasciitis shows relatively less edema in the fascia and histological evidence of localized fibrosis and/or degeneration, including fibrovascular hyperplasia and fibroblastic proliferation, with no evidence of classic inflammation. Several authors have suggested that this condition is more accurately described as ‘plantar fasciosis’. The physical characteristics of plantar fasciosis are similar to those observed with refractory tendinosis, which is recognized as a non-inflammatory, degenerative condition distinct from tendonitis. The current school of thought is that tendinosis, and similarly plantar fasciosis, may be a result of a ‘failed healing’ process, thus a principal objective in treatment is to initiate a localized angiogenic response (increased blood supply) to aid in healing.

Bob Anderson, MD, President of the Orthopedic Foot & Ankle Society has been quoted as stating that 15 million treatments for plantar fasciitis-fasciosis were performed in 2007.

CURRENT TREATMENTS

Conservative treatment options for plantar fasciosis include:
rest, stretching, strengthening, ice water soaks, and massage, progressing to non-steroidal anti-inflammatories, steroid injections with continued recalcitrance. Orthotics, heel cups, night splints, and plantar strapping (taping) are other conservative options frequently recommended by treating physicians. Patient outcomes and response to conservative measures is usually positive with the Weil Foot & Ankle Institute reporting 80% success after six weeks of the basic treatments.
With non-responsive cases, approximately 15% of all presenting cases, cast immobilization and surgical care may be necessary. Extracorporeal shockwave (ESWT) treatment has recently been advocated for the recalcitrant cases.
A study performed by Dr. Lowell Weil, Jr. has shown ESWT to be effective in 70-85 percent in the recalcitrant cases of plantar fasciitis-fasciosis with no complications.
Surgical Plantar fasciotomy or fascia release, either partial or complete is commonly the surgical procedure of choice for treating plantar fasciosis with a reported success of 80-85%.(Dr. Wendy Benton-Weil) However, this surgery has a risk of complications and is thought to alter the biomechanics of the foot, which may be linked to post-operative lateral column pain and medium-term disability. Other complications including nerve damage have also been reported with endoscopic plantar fasciotomy. Plantar, micro-fasciotomy (Radiofrequency Topaz Coblation) of the plantar fascia has also shown a success rate equal to plantar fasciotomy, in a two arm, randomized blinded study. (Dr. Lowell Scott Weil, Sr.)

Lowell Scott Weil, Sr., DPM, FACFAS
Chairman & CEO
Weil Foot & Ankle InstituteDes Plaines, IL
www.weil4feet.com
weil4feet@aol.com

Running & Plantar Fasciitis

2008-12-03T10:46:00.003-06:00

PODIATRISTS IN THE NEWS

ILLINOIS Podiatrist Discusses

Prevention and Treatment of Plantar Fasciitis

Whether you are a regular runner, a weekend warrior, or someone knocking around the yard, foot problems can easily cause you pain. Most pain associated with the heel can be tied to one disorder: plantar fasciitis. "There is a ligament called the plantar fascia which attaches at the heel bone and then runs through the arch and into the toes," explains Lowell Weil, Jr., DPM, team podiatrist for the Chicago White Sox. "Its function is to support the arch. If you bend your toes back, you can feel a tight band in your arch. That is the plantar fascia."

A good preventive measure is stretching exercises two or three times a day. "I don't think the importance of stretching can be over-emphasized," stresses Dr. Weil. "Even if you don't have heel pain, you want to maintain some kind of daily stretching routine. These should be done before exercise and absolutely afterwards."While custom-made orthotics provide the most accurate way to direct the foot into the correct position for walking or running, they are often not necessary as a first-line treatment. "I would say about 80% of my patients respond favorably to over-the-counter inserts," notes Dr. Lowell Weil, JR.

Extracorporeal Shockwave Therapy for the Treatment of Achilles Tendinopathies

2008-11-19T10:11:00.004-06:00

A Prospective Study

Robert Fridman, DPM *, Jarrett D. Cain, DPM, MSc , Lowell Weil, Jr., DPM, MBA and Lowell Weil, Sr., DPM

Weil Foot & Ankle Institute, Des Plaines, IL.

Abstract

Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders.

Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months).

Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1.

Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy.

FLAT FEET

2008-11-13T13:50:00.003-06:00

Flat Feet describes a position of the foot that has kept numerous people out of the armed forces for decades.

However, a flat foot may neither be painful or bad. It may simply be the natural position for those patients to function in. There are many occasions however, where a flat foot can cause other painful conditions to develop and fester.

As an infant, we are born with a flatter foot than an adult to provide an increased base for stabilization. Over the next several years the arch height gradually increases and reaches its highest point some where between the ages of 7-9. From that point on, as we go through life, the arch height actually decreases.

Genetics has a large part to play in the starting position of the foot and arch height; the maximum height the foot reaches between ages 7-9; and how fast the arch breaks down over a life time.

Obviously, a highly active lifestyle also will accelerate the break down of the arch height and structure of the foot.

As the arch height begins to descend and activity remains high enough, the foot begins to develop instability. This instability is exhibited by movement of the bones of the foot. It is necessary for the ligaments, muscles of the foot and leg and the tendons that cross over the major joints to stabilize the bones. As the bones move around secondary conditions can and will develop such as bunions, hammer toes and tailor bunions as well as arthritis. Stress fractures can also develop if unequal amounts of stress are applied to bones over a specific time frame during a time of instability.

The muscles of the leg and their long tendons which insert onto the foot exert a stabilizing effect onto the foot during function. If the foot is unstable enough and the muscle/tendon complex must exert enough of a force, the ligaments, muscle or tendons may become injured during the process.

Conditions such as Adult Acquired Flat Foot (Posterior Tibial Tendon Insufficiency), Plantar Fasciitis, Tendonosis and Synovitis are all soft tissue strains and injuries that develop when the soft tissue is strained beyond its elastic point.

A Flat Foot therefore should be watched. At the first sign of trouble, intervention should be performed to help stabilize the foot and help prevent irreversible injury. Often times, custom orthotics, custom arch supports, can be utilized to stabilize the foot. At other times, the condition may have gone beyond what an orthotic can reasonably protect and surgical correction is utilized to stabilize what nature cannot.

One Man ... Three Perspectives

2008-11-06T15:16:00.003-06:00

A college soccer player, athletic trainer and podiatric surgeon: one man, three different perspectives on injuries to the foot and ankle.

Jeff Baker, DPM, AACFAS – Podiatric Surgeon, Weil Foot & Ankle Institute

When it comes to sports related foot and ankle injuries, I have many different perspectives to draw from. At a relatively later age I became interested in soccer. It started with a game during gym class in the 5th grade where I scored 3 goals. My gym teacher at the time was also the high school varsity soccer coach and he encouraged me to play in the local recreational league. My father was a former high school football and wrestling coach, but he was completely supportive in my pursuit of the game of soccer. Soccer became a year-round part of my life, culminating in playing Division 1 varsity soccer for 4 years at Northeastern University in Boston. Little did I know that later on in life I would become a podiatrist as I participated in a sport played almost exclusively with the feet. Soccer players do some weird things when it comes to their feet. Our cleats are an extension of our feet. So the tighter the cleat, the better touch on the ball. Therefore we purchase cleats that are too small, immediately get them wet, and stretch them to the size of our feet. The cleat ends up fitting like a tight slipper. This brings about injuries and deformities that I have myself and now encounter on a daily basis such as hammertoes and blisters.

When deciding in high school as to what profession I would like to pursue in college, I decided on sports medicine. I was an athletic training major at Northeastern University where during my time I was a student athletic trainer for both the Northeastern University and Tufts University basketball teams. After graduation from Northeastern University in 1992, I then spent four years as the head athletic trainer at Westwood High School in Westwood, Massachusetts. It was a wonderful experience that helped to build relationships with patients. The majority of my athletes had ankle injuries and a large portion of my day was spent taping ankles and providing rehabilitation for ankle injuries. The main purpose of my position was to keep athletes participating in their activities as long as it was safe and not going to worsen any injuries. A unique portion of my duties was to determine the balance between injury and performance. If I could get an athlete with an ankle injury to return to playing with the use of a brace at 80%, does that help team performance or is it a detriment.

In 2000 I graduated from the Ohio College of Podiatric Medicine. I completed a three-year reconstructive foot and ankle surgery residency at St. Mary Hospital in Hoboken, New Jersey and a one-year fellowship in reconstructive foot and ankle surgery at the Weil Foot & Ankle Institute.

The Toe Bones connected to the Foot Bone...

2008-11-06T15:07:00.003-06:00

We have all heard the old refrain, " The toe bone is connected to the foot bone and the foot bone is connected to the ankle bone, the ankle bone is connected to the leg bone...". This is and old rhyme used to teach anatomy to children.

However, most folks do not realize that not only are the bone connected, but they work together as well. What one bone shifts or moves , it will effect the position and structure of other bones that connect to it.

They same is true to groups of bones. Take the foot for instance. The foot connects to the ankle. The ankle connects to the leg. Movement of the foot therefore will effect the action of the leg and visa versa, contracture of the muscles of the leg will effect the movement and position of the foot.

The leg muscles contract normally to help lift the heel bone and push the leg forward during walking. One can see and feel this if they concentrate when they walk. You can feel the calf tighten as the foot gets onto the ball of the foot and the calf squeezes and the foot will push forward. Walking, climbing stairs, running are all activities that will tighten the calf as the muscles must squeeze to help the foot push forward. In fact the only exercise that will stretch the calf is stretching the calf.

Abnormal movement of the foot,usually exhibited by abnormal lowering of the arch which occurs to all of us as we get older from wear and tear as well as by genetics, will cause excessive tightening of the calf muscles. However as the calf muscles tighten, the foot will work more abnormally. This unfortunately will cause the calf muscles to tighten more and the process goes on. Eventually the foot assumes an abnormal position and the calf muscle is excessively tight. This situation usually will cause an overload syndrome of the foot and is a great cause of the development of tendinitis, synovitis, bone bruises, foot fatigue and muscle cramping.

Often times stretching the calf several times a day will help maintain the normal flexibility of the calf and help maintain the normal function of the foot.

Dr. Weil Sr and Dr. Weil Jr Co-Author Important Research on Low Energy Extracorporeal Shock Wave Published in the American Journal of Sports Medicine

2008-10-09T12:13:00.020-05:00

Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis: Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study

Ludger Gerdesmeyer, MD, PhD¹*, Carol Frey, MD², Johannes Vester, PhD³, Markus Maier, PhD⁴, Lowell Weil Jr, DPM⁵, Lowell Weil Sr, DPM⁵, Martin Russlies, PhD⁶, John Stienstra, DPM⁷, Barry Scurran, DPM⁷, Keith Fedder, MD², Peter Diehl, MD⁸, Heinz Lohrer, MD⁹, Mark Henne, MD¹⁰, Hans Gollwitzer, MD¹⁰

¹ Technical University Munich and Mare Clinic
² Orthopaedic Foot and Ankle Center, Manhattan Beach
³ IDV Data Analysis and Study Planning, Biometrics in Medicine
⁴ Ludwig Maximilian University
⁵ Weil Foot and Ankle Institute
⁶ University Schleswig Holstein, Campus Lübeck
⁷ The Permanente Medical Group Inc
⁸ University Rostock
⁹ Institute of Sportsmedicine
¹⁰ Technical University Munich

* To whom correspondence should be addressed. E-mail: gerdesmeyer@aol.com.

Abstract

Background: Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.

Hypothesis: There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.

Study Design: Randomized, controlled trial; Level of evidence, 1.

Methods: Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm²; 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.

Results: Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1sided). No relevant side effects were observed.

Conclusion: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.

Brazil and Foot & Ankle Surgeons from around the World

2008-09-26T10:32:00.002-05:00

Last week, I attended and presented at the International Federation of Foot and Ankle Surgeons Third Annual Congress. This Congress is held every three years and features the premier foot and ankle surgeons (Orthopedic and Podiatric) from around the world. This Congress was held in Bahia, Brazil. Previous Congresses were held in San Francisco, CA and Naples Italy.

Over 500 foot and ankle surgeons from around the World attended this years meeting with less than 50 giving presentations. An incredible amount of interesting research was presented with mid and long term results on emerging techniques and technologies and a wealth of new ideas and procedures.

I was fortunate enough to have two of my papers selected to present. I presented on a new technique that we developed over the last couple of years on repairing the plantar plate of an unstable or dislocated metatarsophalangeal joint. This is a difficult problem without a previous good solution. The paper was well received with most finding this new technique as a good alternative to explore in the future.

Additionally, I presented our longer term results on the Calcaneal Scarf Procedure. This procedure is used to correct painful flatfoot deformity. The benefits of this procedure over others that are currently utilized is that it allows for larger and more stable correction and quicker return to weight bearing.

Dr. Weil, Sr. was an invited speaker who presented his long term experience on the Weil Metatarsal Osteotomy which is a procedure invented by him in the 1980’s and now used worldwide for several specific pathologies of the foot.

Besides the academic aspect of the Congress, it was interesting and enjoyable to spend time with surgeons from all over the World and learning about their countries, cultures and families.

The people of Brazil did an amazing job of putting on a 1st Class Congress and showed the spirit that they are famous.

Lowell Weil, Jr.

Fasciitis and the Firefighter

2008-09-09T13:07:00.003-05:00

I am a 44 year old firefighter that has suffered with chronic heel pain (Plantar Fasciitis) for over 2 years. I also run a few miles several times a week as part of my regular exercise routine. To say that I was frustrated with my pain and the inability to treat it with all the conventional stretching, exercises, inserts, etc is an understatement.

After a referral from my Orthopedic Surgeon to Dr. Lowell Weil Jr., that was about to change. He was completely thorough in his diagnosis and offered several options for treatment. I had surgery, minimal invasive, last December and was back on my feet in 48 hours. Within a week I was back walking in gym shoes and back to the gym on a light workout within a month.

When I say the recovery was quick, it is amazing how good my feet felt. It took Dr. Weil's caution to take it easy at first to keep me from doing more right away. His options for treatment are not offered by all doctors and that's too bad. I have heard horror stories of multiple surgeries with 6 month recovery time. Nonsense - if you suffer from chronic heel pain, give Dr. Lowell Weil Jr. a call, I have referred several people to him and will continue to do so. It is 9 months since my surgery and I have had NO problems what so ever with my heel.

Thank You again Dr. Weil.

Firefighter - Tom (Chicago, IL)

Appreciation!

2008-09-09T12:55:00.003-05:00

Dear Dr. L.S. Weil,

In the twenty years I have been traversing the mazes of medical care, there have been a precious few encounters that measure up to the experience I had last month with you. There have been many who believed they were on top of their game, came highly recommended, splattered with publication, specialization, and honors. Most have schedules requiring weeks of advance booking, with fees to match. You, could teach all of them a thing or two, which, either they never knew or somehow lost along the way.

Thank you. ....for a bedside manner which still emotes curiosity, sensitivity and reasonable rationality... for language that clarified instead of dazzled and dazed...for treating me not only with sharpened professionalism but with kindness, consideration and wisdom you would offer a sister. Thank you for responses to my side-bar chatter, which gave me a glimpse of the man behind the white coat. I left your office informed and encouraged, determined to keep up the good fight, to take the next step, one slightly misaligned foot in front of the other. You delivered the best of what great healers have to offer. And while I know, you know, you are good at your art. You failed miserably the arrogance test.

Great men surround themselves with great subordinates. Every facet of my encounter with your support people; from making the appointment, registering at the desk, giving a history, standing for x-rays, getting copies, or asking follow up questions was handled with patience and professionalism, by individuals who actually felt like they cared enough to get it right and liked what they were doing. There was eye contact, civility, and a sense that one was more than a file or a case to be shuffled. I am still however, undecided about the waiting room. Which do I like best, Boy With Thorn, or cascading water walls? All round, through and through, a class act.

While I don't look forward to the proposed treatment plan, I am reassured and confident that the best man with a great team will be looking out for me.

With My Most Sincere Appreciation,

Mary (Woodstock, IL)

Back to Basketball

2008-09-09T12:02:00.004-05:00

I was devastated in February when I came down for a rebound and couldn’t walk off the court. I saw the end of my NCAA All-Conference Basketball career when a previous podiatrist put me in a walking boot, for my tendon strain. I contacted Dr. Amarantos and after a preliminary visit with him devised a more custom plan of treatment for me. After an MRI, which revealed a ruptured Posterior Tibialis we scheduled a surgery.

Two weeks after surgery I started feeling some relief when the cast was taken off and I returned to a walking boot. Six weeks later I was able to wear my gym shoes with a brace, and I could really notice the vast improvement, I was able to walk with next to no pain for the first time in four months! I was recently cleared for full playing and am grateful for the specialized treatment that I received from Dr. Amarantos.

My fears of missing my senior season did not come true, as the prompt quality treatment got me back on the court for pre-season. I will gladly recommend any of my teammates, family, or friends to Dr. Amarantos, in complete confidence that they would receive top-notch treatment.

Thanks Dr. A!

Lady Reds Captain
Carthage College Kenosha, WI

MRI

2008-08-27T14:27:00.003-05:00

Weil Foot & Ankle Institute installs New MRI

New OrthOne Open High Field MRI-- The magnet architecture permits consistent, very high quality imaging of the extremity powered by a formidable 1-Tesla superconducting magnet optimizing musculoskeletal imaging.

Patients requiring an MRI of the foot, ankle or knee/ lower extremity benefit from a totally non-claustrophobic, quiet, quick, comfortable and convenient experience on the high field extremity system. Because it's designed specifically for extremity applications, no attachment of surface coils or other devices to the imaged anatomy is required. The patient's anatomy is always in the "sweet spot" of the magnet.

Patient Convenience and Comfort - A truly open MRI system.
Completely open design – no claustrophobic tube – only the extremity to be imaged is placed in the magnet.
Ergonomically designed movable chair for optimal patient comfort.
Comfortably accommodates patients up to 350 lbs.
Quiet operation – no loud pulses or noise.
Faster scan times comparable to whole body MRI units – 30 minute average patient study time.
Non-threatening environment–ideal for all patients especially elderly clients/children.

Because the OrthOne is a high-field MRI, doctors can perform surgery with confidence based on the high-resolution images.
A modern Windows-based user interface offers detailed control over scan parameters. Presaturation and Fat Saturation (as well as STIR and a full library of sequences) are standard. The Superconducting magnet delivers outstanding image quality at very fast scan speeds.
A comfortable, non-threatening, non-claustrophobic MRI device that creates scans with extremely high quality images. The scan is performed with you sitting in a comfortable chair. The only part of your body to go into the magnet is the part being scanned.

Boomers not backing down from foot and ankle arthritis

2008-08-08T15:31:00.002-05:00

Surgical advances keeping them active, pain-free

They danced to the Beatles, the Rolling Stones and disco. They worked out with Jane Fonda and made jogging their national pastime.

Now approaching retirement, many members of the "Me Generation" aren't ready to slow down, even if their bodies are. Chicago foot and ankle surgeon Lowell Weil, Jr., DPM, MBA, FACFAS says Baby Boomers are more likely than previous generations to seek care when arthritis develops in their toes, feet and ankles.

There are more than 100 different types of arthritis, including gout and rheumatoid arthritis. According to the American College of Foot and Ankle Surgeons (ACFAS), the most common forms to affect the feet are post-traumatic and osteoarthritis, especially in the big toe, ankle and midfoot joints.

Dr. Weil, Jr. says many Boomers who seek treatment for arthritis assume they'll be able to resume activities such as running or playing sports. Seeking treatment early can improve the odds of preventing irreversible joint damage. For many patients with early-stage foot or ankle arthritis, changes in shoes or advanced custom orthotics can make a huge difference. While there is no fountain of youth for arthritis, Dr. Weil says there are more medical options available to Baby Boomers than ever before.

Big toes

Baby Boomers are most likely to develop osteoarthritis in their big toe joint. During walking, the big toe absorbs forces equal to nearly twice a person's body weight. It plays an important role in stooping and standing. Some boomers start to develop big toe stiffness, a condition called hallux limitus, in their forties.

Better surgical procedures now offer improved pain relief and joint movement to Boomers with early stage arthritis at the big toe. Patients with advanced and severe arthritis may need to have the joint fused or replaced. But stronger screws and hardware are helping fusions last longer while slashing recovery times. A new generation of big toe joint replacements shows promise.

Ankles

Ankles are another prime spot for arthritis. Ankles are more likely to develop post-traumatic arthritis than osteoarthritis. For many Baby Boomers, the trauma was an ankle fracture or a bad sprain that may have happened in their teens or twenties. Innovative new surgical techniques allow foot and ankle surgeons to transplant small plugs of cartilage from one part of the ankle to another in some patients, slowing joint deterioration.

Ankle replacements, however, are not as durable as hip and knee replacements. The ankle is a more challenging joint to replace. It's smaller and moves in multiple directions. But better and promising ankle implants are hitting the market.

Please call us at 847-390-7666 to make an appointment with Dr. Weil, Jr., or visit our website to learn more about Weil Foot & Ankle Institute.