Foot and Ankle Surgery
In-office surgery: Ingrown toenail procedures, hardware removal, cyst excisions and other small cases can be done under local anesthesia alone in the office under a sterile environment. You will usually be asked to have someone take you home afterwards and the postoperative requirements will vary depending on the case.
Outpatient surgery: Our hospital based surgeries will usually be at Overlake Hospital Medical Center or Overlake Surgery Center. You will need to prepare for the surgery by have a preop consultation by your doctor ahead of time and sometime a medical clearance by your general practitioner as well. All of these surgeries will require nothing to eat of drink the night before as well as alteration of your regular medications as decided by your doctor.
Anesthesia: Outpatient surgeries will have an anesthesiologist who will administer sedation through your IV or give you a 'light' general anesthesia. Regardless of the type of anesthesia your doctor will give you local anesthesia before the surgery starts and at the end of the case. Because of the local, your anesthesia requirements will be minimal and you should not have too much nausea or grogginess after the surgery and you should have a numb foot for 1/2 to a full day after surgery. (That's a good thing!)
Pain (or lack of) after surgery: Most of our outpatient surgery patients have little to no pain after surgery. This is because of multiple factors: long acting local anesthesia given at the beginning and end of the case, a steroid injection given intramuscularly at the end of the case, ice applied right after the surgery and high doses of ibuprofen given when you get home. You will be given a narcotic medication just in case, but may not need it.
"Hospital-at-home phase": When you get home from your surgery, we'd like you to be on your back for 99% of the first three days. The 1% of the time would be to go to the bathroom. We'd also like you doing bicycle kicks in the air while still on your back every half hour for one full minute. If you're sleeping, no need to wake up for this. Someone is require to be with you for the first 24 hours preferably longer. You should not get up to cook, clean or wash windows!
Non-weight bearing: If your surgery requires not weight bearing, you will need crutches, a knee scooter, or walker. You might even want to try a wheelchair, I-walk, or Freedom Walker. The latter two are new inventions that make walking without putting weight on you foot a bit easier. Most patients use crutches and possibly a knee scooter. 'Touch down ' weight bearing may be allowed during this phase, which means putting 10 pounds of pressure on your surgery foot.
Cast boot immobilization: You will sometimes be in a postop shoe, with is a flat rigid velcro sandal. These are dispensed at the hospital and sometimes at our clinic. A cast boot is also used. They are also called camwalkers, aircasts, walking boots, and strap on boots. These will be dispensed at our clinic.
Relative rest: As you get back to activities after surgery, we recommend 'alternative podiatric exercises'. We have a specific handout for this. These exercises include cycling, swimming, sitting aerobics, upper body weight lifting...... You will need to beware of overuse injuries as you get back to you previous level of conditioning after surgery. For this reason, we recommend taking it slowly: increasing you activities by only 10% per week!
The syndesmosis bunionectomy
In January of 2017, Dr. Doug and his daughter (a pre-podiatry student) traveled to Hong Kong to visit Daniel Wu, a Canadian trained orthopedic surgeon. Dr. Wu has been performing a unique bunionectomy surgery for over 20 years, and while his results are remarkable, the procedure has never really taken off in the United States. What Dr. Doug witnessed was truly remarkable: postoperative bunionectomy patients, who had both feet operated on, were walking into Dr. Wu's office two weeks after surgery for their first postop visit! Dr. Doug observed firsthand the surgery and follow up of severe bunions with this technique.
Dr. Wu's procedure is a 'syndesmosis bunionectomy' that does not require cutting or breaking the bone unlike almost all other bunionectomy procedures. The metatarsal deformity is manually realigned and held in place with ultra high strength suture while the formation of a ‘new’ ligament between the metatarsals is facilitated with special 'fishscaling' techniques of the adjacent metatarsals and application of platelet rich fibrin. While walking is permitted from day one, it is necessary to avoid too much walking. There is a maximum # of steps per day that are allowed and a reduced rate of walking which are crucial for healing. It is 4-6 months before running or brisk walking for fitness can be done.
'Minimal incision' techniques are employed and foot swelling is much less than with traditional surgery.
Dr. Ichikawa will begin early trials of this surgery on select patients beginning in 2017. It is his hope that this will quickly replace the traditional 'bone cutting' surgeries that are popular today.
Currently there is only one other surgeon worldwide performing this procedure, Dr. Dieter Fellner, of New York City.
Here is his and Dr. Wu’s websites:
http://www.bunioncenternyc.com
Is the syndesmosis bunion procedure for you?
While the syndesmosis bunionectomy procedure allows both feet to be done at one time and allows for immediate walking, certain restrictions will be placed on the patient's walking for 6 months. If these restrictions are ignored, then complications like stress fractures of the metatarsals or recurrence of the bunion will occur. This procedure requires strict adherence to postop protocols.
• You will be required to have a Fitbit or activity tracker to help you limit your walking after surgery.
• Bilateral procedures will not be performed by Dr. Doug for the first several months of his trials.
• A forefoot cast will be utilized at two weeks after surgery for a total of 3 months. This can be seen on Dr. Wu’s postoperative instructions at the bottom of this page.
• A postop shoe or short cam-walker boot will be required for 3 months.
• Monthly visits and x-rays will be required for the first 6 months.
• The use of platelet rich fibrin will be needed and may necessitate a surcharge to the patient of $200.
• If the bunionectomy fails, no significant bridges have been burned and a traditional bunionectomy with osteotomy (bone cut) could be performed later.
• Step requirements are as follows:
• Minimal walking the first month
• 3,000-5,000 steps per day at a slow pace for the 2nd month
• 3,000-5,000 steps per day at an average pace for the 3rd month.
• After three months your can increase your steps per day by 1000 each week.
After four months you can walk unlimited steps in good athletic shoes.
After six months there are no restrictions with shoegear or activity.