Foot

Surgical intervention is considered for more severe or complicated fractures, such as those with multiple fragments or when bones cannot be properly aligned through non-surgical methods. Surgical options may include the use of pins, screws, or plates to hold the bones in place during healing. Post-surgery, a period of immobilization is still necessary, followed by a tailored rehabilitation program to ensure proper recovery. In both surgical and non-surgical treatments, the emphasis is on minimizing weight-bearing activities on the affected foot until substantial healing is achieved, typically monitored through follow-up X-rays and clinical evaluations.

Lisfranc Injuries

Lisfranc injuries, which involve the midfoot region where the metatarsal bones connect with the tarsal bones, can range from mild ligament strains to severe fractures and dislocations of the midfoot. These injuries are often caused by direct trauma, such as a heavy object falling on the foot, or indirect trauma, such as twisting the foot while landing awkwardly. Symptoms typically include swelling, pain, and bruising on the top of the foot, along with difficulty bearing weight. Diagnosing a Lisfranc injury often requires a combination of physical examination and imaging studies like X-rays, CT scans, or MRIs to assess the extent of the damage. Treatment varies based on the severity: mild injuries might only require immobilization and rest, while more severe cases could necessitate surgical intervention to realign and stabilize the bones with screws or plates. Recovery from Lisfranc injuries can be lengthy, often involving several months of rehabilitation to restore full function and strength to the foot.

Minimally Invasive Bunion Correction

Minimally invasive bunion correction is an advanced surgical technique designed to realign the big toe and correct the bunion deformity with minimal tissue disruption. Unlike traditional open bunion surgery, this approach involves making small incisions and using specialized instruments to remove the bony prominence and realign the big toe. The minimally invasive procedure typically results in less pain, reduced scarring, and a quicker recovery time. Patients can often bear weight on the foot sooner than with conventional invasive bunion surgery, and the risk of complications such as infection and stiffness is significantly lower. Postoperative care includes wearing a protective shoe and engaging in physical therapy to ensure proper healing and restore function of the great toe. This technique is becoming increasingly popular due to its effectiveness and the benefits of a less invasive approach.

Smaller incisions for less postoperative pain

Small “percutaneous” incisions act as entry portals for the specialized instruments surgeons use to perform the procedure. The 1/8 to 1/5 inch incisions are made on the side of the foot, as compared to traditional bunion surgeries performed through a 2 to 6 inch incision on the top of the foot (“open” surgery).

Recover up to 8 weeks faster

On average, patients recover up to 8 weeks faster with the Arthrex Minimally Invasive Bunionectomy compared to open procedures. Most patients are able to walk away from surgery without assistance of a knee scooter or crutches, and are able to return to driving and other daily activities sooner.

Dr. Neary’s experience in minimally invasive bunion surgery is particularly unique and valuable due to the precision, skill, training, and experience required for this advanced technique. Mastery in this field indicates a high level of expertise in using specialized instruments and technology to perform delicate procedures through small incisions. Experienced minimally invasive surgeons can navigate the complexities of foot anatomy with minimal disruption to surrounding tissues, leading to superior outcomes such as reduced postoperative pain, faster recovery times, and lower risk of complications. Dr. Neary’s proficiency in minimally invasive surgery reflects a commitment to staying at the forefront of surgical advancements, continuously refining skills and incorporating the latest innovation into her practice. This level of expertise not only enhances patient outcomes but also instills greater confidence in patients, knowing they are in the hands of a surgeon capable of delivering the most modern and effective treatment available.

For more information about minimally invasive bunion correction, please visit www.boisebunion.com

Minimally Invasive Lesser Toe Correction

Minimally invasive lesser toe surgery represents a significant advancement in foot and ankle surgery, offering patients a less invasive and more precise approach to correcting deformities such as hammertoes, claw toes, and mallet toes. This technique involves making small incisions and using specialized instruments to access and address the underlying toe joint abnormalities, often resulting from imbalances in muscle and ligament tension. By preserving more healthy tissue and minimizing trauma, patients experience reduced postoperative pain, faster recovery times, and improved cosmetic outcomes compared to traditional open surgery. As a surgeon skilled in minimally invasive lesser toe surgery, Dr. Neary demonstrates a nuanced understanding of foot biomechanics and possesses the dexterity to navigate intricate structures with precision, ensuring optimal realignment and function of the affected toes.

For more information about minimally invasive lesser toe correction, please visit www.boisebunion.com

For more information about minimally invasive lesser toe correction, please visit www.boisebunion.com

Plantar Plate Injuries

Plantar plate injuries involve damage to the ligamentous structure located on the bottom of the toe, specifically under the metatarsophalangeal joints (the ball of the foot). This injury typically occurs due to excessive stress or trauma, often associated with activities that involve running, jumping, or high-impact movements. Symptoms can include pain, swelling, and instability in the affected toe, commonly the second toe, which may start to drift upwards or sideways. Diagnosis is typically confirmed through physical examination and imaging techniques such as MRI or ultrasound. Treatment can range from conservative methods like rest, ice, and physical therapy to more invasive options like corticosteroid injections or surgery, depending on the severity of the injury. Early intervention is crucial to prevent chronic issues and ensure optimal recovery.

For more information about plantar plate injuries and Dr. Neary’s experience with plantar plate repairs, you can watch Simplifying the Plantar Plate Repair

Great Toe Arthritis (Hallux Rigidus)

Great toe arthritis, also known as hallux rigidus, is a degenerative condition affecting the metatarsophalangeal (MTP) joint of the big toe. This form of arthritis is characterized by the progressive wear and tear of the cartilage within the joint, leading to pain, stiffness, and reduced mobility. Patients often experience discomfort during activities that involve toe movement, such as walking or running, and may notice swelling and a bony bump on the top of the joint. Over time, the range of motion in the big toe can significantly diminish, causing difficulty with normal gait and footwear selection. Diagnosis typically involves physical examination, patient history, and imaging studies like X-rays to assess the extent of joint degeneration. Treatment options include conservative measures such as nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics, steroid injections, and physical therapy, as well as surgical interventions including cheilectomy (bone spur removal) or great toe fusion (in more severe cases). Early detection and management are essential to alleviate symptoms and maintain function of the great toe.

Great Toe Fusion 

1st MTP Joint Preservation Surgery

Preservation of the first metatarsophalangeal (MTP) joint is a crucial goal in managing conditions like hallux rigidus or mild to moderate arthritis, aiming to maintain joint function and delay or avoid the need for great toe fusion surgery. Strategies for joint preservation often include a combination of conservative treatments such as physical therapy to improve range of motion and strengthen surrounding muscles, orthotic devices to reduce stress on the joint, steroid injections, and nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. In some cases, surgical procedures including cheilectomy (removal of bone spurs) or interpositional arthroplasty (placing a biologic spacer in the joint) are employed. Advances in regenerative medicine, such as platelet-rich plasma (PRP) injections or stem cell therapy offer potential for repairing damaged cartilage and promoting joint health. Early intervention and a tailored treatment plan are essential to preserve the function and integrity of the first MTP joint, ultimately enhancing the patient’s quality of life and mobility.

Cheilectomy (bone spur removal):

Great toe cheilectomy is a surgical procedure designed to alleviate pain and improve mobility in patients suffering from hallux rigidus, a condition characterized by stiffness and arthritis in the first metatarsophalangeal (MTP) joint. During a cheilectomy, Dr. Neary removes bone spurs and any other bony overgrowths that have developed around the joint, which are often responsible for pain and restricted motion. This debridement helps to increase the range of motion and reduce discomfort by clearing space for the toe to move more freely. Recovery from a cheilectomy typically involves a period of rest and gradual return to weight-bearing activities, with physical therapy to aid in regaining strength and flexibility. Cheilectomy is generally recommended for patients with mild to moderate arthritis and has a high success rate in relieving symptoms and delaying the progression of arthritis, thus preserving joint function and enhancing overall function of the great toe.

Interpositional Arthroplasty:

Interposition arthroplasty of the great toe is a surgical procedure aimed at relieving pain and restoring some degree of mobility in patients with severe arthritis or joint damage in the first metatarsophalangeal (MTP) joint. Unlike joint fusion, which eliminates movement, interposition arthroplasty involves removing the damaged joint surfaces and placing a soft tissue graft or synthetic spacer between the bone ends. This spacer acts as a cushion, preserving some joint motion while reducing pain and preventing bone-on-bone contact. The procedure can be particularly beneficial for patients who seek to maintain flexibility and function in the big toe. Interposition arthroplasty offers an alternative to joint fusion, providing pain relief while maintaining a more natural toe motion.

Foot Cartilage Preservation

Foot cartilage preservation is essential in managing and preventing degenerative joint conditions, such as osteoarthritis, to maintain optimal foot function and mobility. Strategies for preserving cartilage involve both conservative and advanced surgical approaches. Conservative measures include weight management to reduce joint stress, physical therapy to strengthen the muscles supporting the foot, and orthotic devices to distribute pressure evenly. Nonsteroidal anti-inflammatory drugs (NSAIDs) and supplements like glucosamine and chondroitin may help manage symptoms and support joint health. Advances in regenerative medicine, such as platelet-rich plasma (PRP) injections and stem cell therapy, show promise in promoting cartilage repair and regeneration. Early intervention and a proactive approach to joint health are crucial, involving regular monitoring and timely treatment of foot injuries or abnormalities. By prioritizing cartilage preservation, patients can potentially delay or avoid more invasive procedures, maintain a higher quality of life, and ensure long-term foot health.

Charcot Foot Reconstruction

Charcot arthropathy, also known as Charcot foot, is a severe and progressive condition often (but not always) associated with diabetes, where the bones, joints, and soft tissues of the foot and ankle are weakened and eventually destroyed due to peripheral neuropathy, or nerve damage. This neuropathy results in a loss of sensation, meaning injuries or fractures may go unnoticed and untreated, leading to further damage as the patient continues to walk on the affected foot. This can result in collapse of the arch over time, creating a “rocker bottom” foot deformity. The condition typically progresses through stages, starting with acute inflammation and bone resorption, followed by joint dislocation and deformity, and finally leading to chronic changes and potential foot ulceration. Symptoms include swelling, redness, and warmth in the affected area, often mimicking an infection. Diagnosis is confirmed through clinical evaluation and imaging studies such as X-rays, MRI, or CT scan. Early detection and treatment are crucial, often involving immobilization with a cast or brace to protect the foot, offloading to prevent further damage, and in severe cases, surgical intervention to stabilize and reconstruct the foot. Managing Charcot arthropathy requires a multidisciplinary approach to prevent complications, preserve foot structure, and maintain mobility. 

Surgery for Charcot arthropathy is typically considered when conservative treatments fail to stabilize the foot or when significant deformity, instability, or chronic ulcers develop that do not respond to non-surgical management. Indications for surgery include persistent pain, recurrent or non-healing ulcers, severe bone and joint dislocations, or fractures that compromise foot function and structure. Surgery may also be necessary when there is a high risk of infection due to ulceration, or when the deformity severely limits mobility, thus affecting the patient’s quality of life. Timing is critical; surgery should ideally be performed during the quiescent phase of Charcot foot when inflammation has subsided, as this reduces the risk of complications and enhances healing outcomes.

Dr. Neary has developed a minimally invasive approach to Charcot arthropathy which offers numerous benefits compared to traditional open surgical methods. This technique involves smaller incisions, which reduce the risk of infection and promote faster healing, a critical advantage for patients who often have compromised healing capacities due to conditions such as diabetes. The precision of this technique helps in preserving as much healthy tissue as possible, which is essential in maintaining foot stability and function. Additionally, the reduced trauma to the soft tissues and bones minimizes the risk of further complications, such as nonunion or new fractures. Overall, taking a minimally invasive approach to Charcot surgery enhances patient outcomes by improving recovery times, reducing the likelihood of complications, and maintaining a better quality of life during the postoperative period.

Flatfoot Reconstruction

Flatfoot deformity, also known as pes planus, is a condition characterized by the collapse of the foot’s arch, resulting in the entire sole making contact with the ground. This deformity can be congenital or acquired, with causes ranging from genetic predisposition and ligament laxity to posterior tibial tendon dysfunction (PTTD) and arthritis. Symptoms often include pain, swelling along the inside of the ankle and foot, and difficulty standing on tiptoe or walking long distances. The altered foot mechanics can lead to secondary issues such as plantar fasciitis, Achilles tendonitis, and knee, hip, or lower back pain due to improper weight distribution and alignment. Diagnosis typically involves a physical examination and imaging studies like X-rays or MRI to assess the extent of the deformity and associated damage. Treatment options vary based on severity and may include orthotic devices, physical therapy, anti-inflammatory medications, steroid injections, and in severe cases, surgical intervention to correct the deformity, realign the bones, and restore function. Early detection and intervention are crucial to manage symptoms effectively and prevent further complications.

Surgical correction of a flatfoot deformity may be considered when conservative treatments such as orthotics, physical therapy, and medications fail to alleviate symptoms or when the deformity significantly impairs function and quality of life. The specific surgical approach depends on the severity and underlying cause of the deformity. Common procedures include osteotomies, which involve cutting and realigning bones to restore the arch, and tendon transfers, such as using the flexor digitorum longus tendon to support the damaged posterior tibial tendon. In cases of severe deformity or arthritis, joint fusion (triple arthrodesis) may be performed to stabilize and realign the foot. Additionally, soft tissue procedures like ligament reconstruction may be necessary to address associated ankle or foot instability. The goal of surgical correction is to relieve pain, improve foot function, and correct the deformity, ultimately enhancing mobility and quality of life. Postoperative care typically involves a period of immobilization followed by rehabilitation to ensure optimal recovery and long-term success.

High Arch (Cavovarus) Correction

Cavovarus foot deformity is a condition characterized by an excessively high arch (cavus) and an inward turning of the heel (varus). This deformity often results from neuromuscular disorders, such as Charcot-Marie-Tooth disease or spinal cord anomalies, but can also arise from trauma or idiopathic causes. The abnormal foot structure leads to an uneven distribution of weight across the foot, often causing pain, instability, and difficulty with walking. Treatment typically involves a combination of orthotic devices to provide support and improve alignment, physical therapy to strengthen and balance the muscles, and in severe cases, surgical intervention to correct the deformity and improve function. Early diagnosis and intervention are crucial to managing symptoms and preventing further complications.

Surgical correction of cavovarus foot deformity aims to restore proper foot alignment, improve function, and alleviate pain. The specific surgical approach depends on the severity and underlying cause of the deformity. Common procedures include osteotomies to reshape and realign the bones, tendon transfers to balance muscle forces, and soft tissue releases to improve flexibility. In some cases, joint fusions may be necessary to stabilize the foot. Preoperative planning is critical, often involving imaging studies and gait analysis to tailor the surgical plan to the patient’s unique anatomy. Postoperative care includes immobilization, gradual weight-bearing, and physical therapy to ensure proper healing and functional recovery.

Midfoot Arthritis

Midfoot arthritis refers to the degeneration of the joints in the middle section of the foot, which can significantly impair mobility and quality of life. This condition often arises due to wear and tear over time, previous injuries, or inflammatory diseases such as rheumatoid arthritis. Symptoms typically include pain and swelling in the midfoot area, stiffness, and difficulty with walking or standing for extended periods. The pain may worsen with activity and improve with rest. Diagnosis is made through a combination of clinical examination and imaging studies, such as X-rays or MRIs. Treatment options range from conservative measures like anti-inflammatory medications, orthotic devices, and physical therapy, to more invasive approaches such as steroid injections or surgical interventions like joint fusion or realignment procedures. Effective management of midfoot arthritis aims to reduce pain, improve function, and maintain an active lifestyle for the patient.

Morton’s Neuroma

Morton’s neuroma is a painful condition affecting the ball of the foot, most commonly between the third and fourth toes. It involves the thickening of the tissue surrounding one of the nerves leading to the toes, often due to irritation, excessive pressure, or injury. Symptoms typically include sharp, burning pain, tingling, or numbness in the affected area, and patients often describe feeling as if they are standing on a pebble. The pain may worsen with activities that involve weight-bearing or wearing tight shoes. Diagnosis is usually based on physical examination and imaging studies like ultrasound or MRI to confirm the presence of the neuroma. Conservative treatment options include wearing wider shoes, using orthotic inserts, and taking anti-inflammatory medications to reduce pain and inflammation. In more severe cases, corticosteroid injections or surgical removal of the neuroma may be necessary to provide relief. Early intervention is key to preventing the progression of symptoms and ensuring better long-term outcomes.

Surgical management for a painful neuroma involves the removal of the affected nerve tissue. The procedure is done on an outpatient basis under local or general anesthesia. During surgery, Dr. Neary makes an incision on the top of the foot to access and excise the irritated nerve. This excision aims to permanently eliminate the source of pain and discomfort. Recovery from neuroma surgery generally includes a period of rest, elevation, and limited weight-bearing to allow the foot to heal properly, followed by physical therapy to restore strength and mobility. Potential risks of the surgery include infection, scar tissue formation, and the possibility of persistent or recurrent pain if the nerve regrows. Despite these risks, neuroma surgery has a high success rate in providing significant pain relief and improving quality of life for patients suffering from this debilitating condition.

Plantar Fasciitis

Plantar fasciitis is a common and painful condition caused by inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. It is often characterized by sharp, stabbing pain in the heel, particularly noticeable with the first steps in the morning or after prolonged periods of rest. Risk factors for plantar fasciitis include excessive running or walking, wearing unsupportive footwear, obesity, and having an abnormal foot structure, such as flat feet or high arches. Diagnosis is typically based on a physical examination and patient history, although imaging tests like ultrasound or MRI can be used to rule out other conditions. Treatment focuses on reducing inflammation and pain, and may include rest, ice, stretching exercises, orthotic devices, and nonsteroidal anti-inflammatory drugs (NSAIDs). More severe or persistent cases might require physical therapy, corticosteroid injections, or, in rare instances, surgical intervention to release the tight fascia. Early intervention and adherence to a comprehensive treatment plan are crucial for effective management and prevention of chronic symptoms.

Tarsal Coalition

Tarsal coalition is a congenital condition characterized by an abnormal connection between two or more bones in the foot, specifically within the tarsal region. This abnormal fusion can involve various tarsal bones, but the most common types are talocalcaneal and calcaneonavicular coalitions. These coalitions can be composed of bone, cartilage, or fibrous tissue, leading to restricted foot movement, pain, and a tendency towards ankle sprains or flatfoot deformity. Symptoms often become apparent during late childhood or adolescence, as the coalition ossifies and stiffens. Diagnosis is typically confirmed through imaging studies like X-rays, CT scans, or MRIs. Treatment options vary based on the severity of symptoms and the degree of bone fusion, ranging from conservative approaches such as orthotics and physical therapy to alleviate pain and improve mobility, to surgical interventions that may involve resecting the coalition or fusing affected joints to restore function and relieve discomfort. Early detection and appropriate management are essential for preventing long-term complications and improving patient outcomes.