Onsite foot surgeries can be performed in our Brooklyn podiatrist office or in the state-approved surgical center. Dr. E, a reputable NYC podiatrist at Best Foot Doctor NY, specializes in bunions, reconstructive foot surgery, trauma, and athletic injuries, as well as surgical and non-surgical treatments for neuromas, tendons, 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 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 ensure there is no bone spur present or infection of the bone, particularly when the condition has a 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, resulting 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 or injury, or it may be inherited. Sometimes, additional diagnostic tests, such as a nail culture, may be required. Fungal nails can often be treated with new oral antifungal agents. When pain persists or conservative measures fail to provide adequate relief, 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. Fungal 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, along with the removal of any fungus tissue that may be present. The root of the toenail is then treated with a chemical agent that destroys it. If the entire toenail needs to be removed, the same procedure is employed for the entire tissue under the nail and the complete root.

CONCLUSION
There are additional treatment options to consider for this common foot problem. 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 afflicting 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 numerous problems, both 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 an inability to wear shoes comfortably. If left untreated, these conditions can progress to ulcers or infections.

A flexible hammertoe is a reducible hammertoe, in contrast to a 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 result in a 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 abnormalities in the tendon, ligaments, or skin, often resulting in 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 pressure against the skin manifests as thick, hardened skin, commonly referred to as corns. Corns are most often the result of an en­larged bone or bone spur pinching the skin against a shoe. A corn can also indicate 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, causing the skin to pinch. 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, an outpatient surgical center, or as a one-day hospi­tal surgery. Our onsite foot surgeries are convenient and performed by our top podiatrist surgeons.

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 the re­moval of cartilage and bone in remodeling a deformed joint. It provides relief to 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 on caring for 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 wearing shoes comfortably and performing 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 calf muscles. It bears all of the body`s weight with each step. The stress placed on the heel bone and its associated structures is tremendous, making them susceptible to plantar fasciitis or heel spur syndrome.

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

Plantar fasciitis and heel spur syndrome are often caused by biomechanical faults. Biomechanical faults refer to abnormalities such as flexible flat feet, high-arched foot deformities, and a tight Achilles tendon. These disorders place a greater strain 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. The inflammation of the plantar fascia is the cause of the pain. Treatment is directed at reducing stress on the plantar fascia and decreasing inflammation at its attachment. 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 partially released from its origin. When a large spur is present, reduction or removal could become necessary. Advances in surgical technology now permit plantar fascial release to be performed 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
Your doctor assesses your preoperative considerations, which include your age, occupation, physical activities or limitations, and general health status. Surgery can be performed in the office, an outpatient surgical center, or as a one-day hospital surgery.

POSTOPERATIVE CARE
After surgery, you will receive instructions on caring for 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 onsite foot surgeries listed here, we also offer flat foot surgery, bunion surgery in NYC, as well as other valuable services.