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Welcome to the InStep Foot and Ankle SERVICES information page. We are the premier provider of podiatry. Our goal is to provide the very best in Foot and Ankle care. Our goal is to provide you with a comfortable enviroment "Where Health And Care Meet". We want you, our valued customer, to be happy. Follow is a listing of many of our services in a CASE STUDY FORMAT.
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Patient with chronic pain bilateral feet and legs. Presenting with hx of "Growing Pains" aggrevated with activity. Recalcitrant to conservative care of orthotic therapy and stretching. Extraarticular placement of Subtalar Joint Implant to control hypermobility of rear and midfoot region results in arch restoration, as foot continues to develop in corrected position. Patient ambulatory, to tolerance, post-op.
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Many procedures, to address the complaints commonly associated with the abnormal foot motion, have been developed over the years. Prior surgical approaches, involved multiple bone cuts and fusions, requiring prolonged healing and pain to the patient. Many, of which, must be delayed, until skeletally mature and the deformity is permanent. These procedures, increase risk for long term need of additional procedures or customized shoe gear to compensate for lost foot function, sacrificed to achieve stability to the walking patient. Less invasive options have been described as early as the time of Napoleon. Historically, the surgery has been limited to pediatric patients or very select adult problems due to less-than-adequate implant design, placement and patient tolerance. Recent advancements have opened up the doors to broader applications, addressing problems where they start, rather than placating the symptoms. The following is to address and introduce the combination of therapies to allow both the internal and external approaches, now available, to address excessive foot motion / compensation and its resulting complaints. |
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SKIN PROBLEMS |
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Personal patient with slow, progressive onset of pain of toe. X-ray showed some radiolucency in the toe bone. History of prior nail removal and also prior malignant melanoma removal. Sharp, intermittent pain with/without bumping the toe. Some thickened callus in region of prior nail removal. With prior history of cancer and nail removal, opted for skin ellipse with biopsy of underlying bone. Pathology reports were clear for bone infection or tumor involvement. Skin portion revealed tumor cells positive for desmin (smooth muscle marker) consistent with Glomus Tumor. Wound healed uneventfully with resolution of original symptoms. |
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Personal patient presented with painful callus on bottom of the 1st toe. Was warty in appearance. Walking made it worse, putting pressure on the bottom of the big toe. X-rays revealed extra bone in the big toe joint creating prominence and pressure to bottom of joint. Trimming and injections to the callus did not help. Surgical removal of the extra bone resolved the pain and the superficial callus went away. Patient was able to walk without it hurting anymore, and healed fine. Patient requested it done to the other big toe. |
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Personal patient with traumatic fracture of the side of the ankle bone (talus). Opted to repair fragment, because of the potential for joint problems if the fragment was removed. Compression pin fixation gave adequate reduction of the fracture. Patient was non-weightbearing for 4 weeks after the surgery. At 7 weeks, patient went snowboarding, against medical advice. Patient sent for physical therapy and seemed to be doing well, in spite of not doing what the doctor had told him to do. |
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Personal patient presents 1 ½ weeks following having foot stomped on, without prior treatment. X-ray showed large, displaced joint fracture of 5th metatarsal base. Under local anesthesia, bone edges were freshened and realigned. Fixation achieved with a tension-band technique. Pateint was nonweightbearing for the first few weeks with progression into a weightbearing cast, and subsequently, unrestricted shoegear. |
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TENDONS |
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Personal patient walking across parking lot heard an sudden pop with pain to lower leg. Denied trauma or prior hint of a problem. Had continued pain with and without activity. Exam caused pain with motion of the ankle, but could be isolated to motion of the flexor tendon of the big toe. X-ray did not show anything. MRI showed a partial tear to the muscle-tendon junction of the flexor hallucis longus tendon. Patient refused surgical options. Patient maintained nonweightbearing, in cast, for 4 weeks. Patient went on to walk without compliant and healed uneventfully. |
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Patient with hammertoes have been traditionally encumbered with the thought of extreme post op pain, painful, poorly-placed scars, or troublesome hospital red tape, to get relief. A medially placed incision addresses the concerns with incisional placement in an area that avoids shoe pressure, anatomically preserves vital structures, and cosmetically hides the incision. The surgery is an outpatient approach, under local anesthesia, minimizes risk and time constraints to patient. Ambulatory, immediate postop, in cast walker, patient avoids postop potential for DVTs. Even the DIABETIC benefits with addressing ulcer-causing deformity.
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