Onsite foot surgeries can be performed in our Brooklyn podiatrist office or in the state approved surgical center. Dr. E, a reputable NYC podiatrist, specializes in bunions reconstructive foot surgery, trauma and athletic injuries, surgical and non-surgical treatment for neuromas, tendon and joint pain.

Information and Surgical Options for Toenail Problems

TOENAIL SURGERY
Toenail surgery is employed to alleviate the following types of deformities.
• Ingrowing Toenail
• Incurvated Nail
• Fungus Nail
• Thick Nail (Hypertrophied)
• Injury to a Toenail

INGROWN TOENAIL AND INCURVATED NAIL
This is a condition in which a portion of the nail presses into the flesh, causing pain, redness, and sometimes infection. If this condition is left untreated, an exaggerated swelling of the skin along the nail border, known as proud flesh, can form.

TREATMENT
Ingrown toenail surgery is usually per­formed under local anesthesia or with topi­cal anesthetic agents. Preoperative X-rays may be taken to be sure there is no bone spur present or infection of the bone when the condition is of chronic duration. Re­moval of a portion of the nail border caus­ing the problem will give temporary relief. Permanent correction to remove the offend­ing portion of the nail and nail root could be required if this is a recurring problem.

SUBUNGUAL EXOSTOSIS (Bone Spur Under the Nail)
Sometimes deformed nails are associated with a small bone spur at the tip of the toe under the nail. This can cause considerable discomfort at the nail or beneath it. The skin between the nail and the bone can become irritated and result in a painful corn or cal­lus. If the nail is removed, without remov­ing the bone spur, the corn or callus can continue to form on the tip of the toe. There­fore the most effective way to treat this con­dition is to also remove the spur.

THICKENED DEFORMITY OF TOENAILS
This condition can stem from a nail fungus, nail injury or it may be inherited. Sometimes other diagnostic tests, such as a nail culture, could be required. Fungus nails can often be treated with new oral antifungal agents. When pain persists or conservative measures fail to give adequate relief of pain, treatment may require removal of the nail and destruc­tion of the nail root.

LASER SURGERY
This involves the use of a special high fre­quency laser. Fungus tissue and nail can be removed on a permanent basis when the nail root or growth center is destroyed with a laser.

CHEMICAL CAUTERIZATION FOR PERMANENT NAIL REMOVAL
This procedure involves the permanent removal of one or both sides of a toenail and the removal of fungus tissue if it is present. The root of the toenail is then treated with a chemical agent that destroys it. If the entire toenail needs removed, the same procedure is employed for the entire tissue under the nail and the complete root.

CONCLUSION
There are additional methods of treatment for this common foot problem to consider. This includes oral and/or topical medication for toenail fungus, especially if surgical cor­rection is not desired or possible due to medical circumstances.

Information and Surgical Options for Toe Deformities

DIGITAL/TOE DEFORMITIES
A deformed toe is one of the more common conditions known to afflict the foot, whether it be a hammertoe, mallet toe or overlap­ping toe.

HAMMERTOES
A hammertoe is a flexible or rigid contrac­tion usually affecting the second, third, fourth or fifth toes. Most often a biomechanical abnormality results in the larger muscles of the foot and leg overpowering the smaller intrinsic muscles of the foot. Muscle imbalance leads to a bending or “buckling” of the toe joints. These buckled or contracted positions create any number of problems within and on top of the toe deformity.

One or more small joints become prominent on top of the malpositioned toe. Tendons, ligaments and joint capsules in that area have a greater chance of tightening and shortening. Shoe irritation of the deformed digit results.in corns, skin inflammation and inability to wear shoes comfortably. If left untreated, these conditions can progress to ulcers or infections.

A flexible hammertoe refers to a reducible hammertoe in contrast to the rigid hammer­toe where the deformity is fixed or not easily straightened. There are many causes of hammertoes. Some are congenital, hereditary or acquired. An inherited condition may mean an inherited muscle imbalance around the toe or a parent with an abnormally long toe. An acquired hammertoe refers to those caused by short stockings or short/pointed shoes, espe­cially where a long toe is present. Arthritic patients and those with diabetic neuropathy can be more susceptible to hammertoes.

MALLET TOE
A mallet toe is similar to a hammertoe, except the deformity occurs closer to the end of the toe.

MALLET TOE OVERLAPPING TOE
An overlapping toe is one that is malpositioned from birth or acquired over time. It often produces some abnormality in the tendon, ligaments or skin, many times producing painful corns.
All of the toe deformities mentioned can lead to other positional deformities, enlarge­ment of bone tissue or bone spurs. Shoes further aggravate these conditions and can cause additional pain, inflammation and corns.

OVERLAPPING TOE CORNS
The body’s response to excessive amounts of pressure against the skin manifests itself by forming thick, hardened skin or corns. Corns are most often the result of an en­larged bone or bone spur pinching the skin against a shoe. A corn can be indicative of a pressure point between the toes.
Soft corns refer to corns that exist between the toes. They are the result of two bones rubbing against each other, pinching the skin. Sometimes more than one soft corn will form.

TREATMENT
Conservative treatment can consist of one or more of the following.
1. Trimming, digital splinting and/or pad­ding of the corn.
2. Orthotics or inserts in shoes to correct improper walking.
3. Injections to relieve pain and inflamma­tion.
4. Larger or extra depth shoes to accommo­date toe deformities.
If these conservative methods are unsuc­cessful in treating your deformity, then cor­rective toe surgery should be considered.
The surgical correction of your toe defor­mity may be performed in the office, out­patient surgical center or as one-day hospi­tal surgery.

DIGITAL/TOE SURGICAL OPTIONS
These procedures help to straighten the toes by cutting the bone, tendon, joints and/or ligaments.

1. TENOTOMY AND CAPSULOTOMY
The terms tenotomy and capsulotomy refer to the cutting of tendons and joint capsules. More specifically in relation to hammertoe deformities, the tight tendons and joint cap­sules located on the top and bottom of the buckled or contracted toe joints are released. 
Once these tight, soft-tissue structures are cut and relaxed, the toe can resume its nor­mal flattened posture.
2. ARTHROPLASTY
This very popular procedure involves re­moval of cartilage and bone in remodeling a deformed joint. It allows for relief of the painful area.
3. ARTHROPLASTY WITH FIXATION FOR FUSION
This procedure involves joint removal and the use of a wire (pin) to stabilize or fuse the deformed toe. 
4. ARTHROPLASTY WITH TENDON RELOCATION
A joint space is created and the toe is re­aligned by relocating the flexor tendon, which pulls the toe down.
5. ARTHROPLASTY WITH IMPLANTATION
Following excision of a joint, a plastic im­plant is placed inside to act as a functional spacer.
6. DEROTATION/ REALIGNMENT PROCEDURE FOR OVERLAPPING TOE
A wedge of skin and a segment of bone are removed to realign the overlapping toe.
7. BONE SPUR REMOVAL
An incision is made and an instrument is used to file or excise the bone spur and re­move the source of increased pressure.
8. OSTEOTOMY
A cut is made through the bone to allow it to be realigned. Wire or pin fixation could be required.
POSTOPERATIVE CARE
After surgery, you will receive instructions regarding the care of your dressings, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling.

CONCLUSION
Painful toe deformities prevent patients from being able to wear shoes comfortably and perform their normal activities.

Information and Treatment Options for Heel Spur Syndrome and Plantar Fasciitis

HEEL SPUR SYNDROME PLANTAR FASCIITIS
The heel bone or calcaneus is the largest bone in the foot and projects backward beyond the leg bones to provide a useful lever for the muscles of the calf. It bears all of the body`s weight with each step. The stress placed on the heel bone and its associated structures is tremendous and makes it susceptible to what is known as plantar fasciitis or heel spur syndrome.

The pain that results from these disorders is caused by the inflammation at the interface of the plantar fascia and heel bone. The plantar fascia constitutes the long band of fibers attached at the bottom of the heel bone and extend to where the toes begin. It also helps create the arch of the foot.

Plantar fasciitis and heel spur syndrome are usually the result of biomechanical faults. Biomechanical faults refer to such abnormalities as flexible flat feet, high-arched foot deformities and a tight Achilles tendon. These disorders place a greater amount of stress on the plantar fascia.

Other causes of stress on the heel and plantar fascia include recent weight gain, high-impact athletic activities, prolonged standing or walking, trauma, lower back problems and arthritis. Pain could also stem from a microtraumatic fracture of the heel, causing a heel spur as a result of this injury.

TREATMENT
A heel spur may or may not be present on an X-ray. Not all heel spurs hurt. It is the inflammation of the plantar fascia that causes the pain. Treatment is directed at reducing stress on the plantar fascia and decreasing inflammation at the attachment of the plantar fascia. It usually involves rest, heel cups, stretching, physical therapy modalities, strapping, orthotics, steroidal injections and non-steroidal, anti-inflammatory medications.

In a minority of cases when the above conserva­tive measures fail to give relief, surgical intervention becomes necessary .The plantar fascia is released in part from its origin. When a large spur is present, reduction or removal could become necessary. Advances in surgical technology now permit plantar fascial release via the endoscope. This procedure is known as Endoscopic Plantar Fascial release or EPF. Extracorporeal Shockwave Therapy is also a new modality that is available.

PREOPERATIVE CONSIDERATIONS
Preoperative considerations are assessed by your doctor and include your age, occupation, physical activities or limitations and general health status. Surgery can be performed in the office, outpatient surgical center or as one-day hospital surgery.

POSTOPERATIVE CARE
After surgery, you will receive instructions regarding the care of your dressings, your level of activity and weight-bearing. As with all foot surgery, rest and elevation can help reduce pain and swelling.
An orthotic could be recommended to control the abnormal bio­mechanical forces and thus prevent recurrence of the symptoms. In addition to the surgeries listed here, we also offer flat foot surgery, bunion surgery in NYC, as well as other valuable services.