Podiatrist Uses New Techniques for Common Foot Problems
By Dr. Debra E Young, DPM

FAST RECOVERY WITH LESS INVASIVE SURGERY
(OR WE SHOULD SAY, in by 9 and out by 10)

Dr. Debra Young can now use one small incision to perform plantar fasciotomies or Morton’s neuroma decompressions in a matter of minutes. Known as the Isogard system or the Koby procedure.  These new techniques are performed by placing the Isogard device through the tiny incision.  This instrument looks like a flat tiny tuning fork.   The two tines are placed above and below the fascia or ligament.  A smaller amount of the fascia is released than with the endoscopic procedure.  Once the desired section of ligament or fascia has been released one or two small stitches are all that is needed to close the incision.  Since this new surgical system does not require the use of any special endoscopic equipment, the Koby procedures can been performed in a minor surgical procedure room eliminating additional costs to insurance companies, surgery facilities and, most importantly, patients.

Everybody has felt it at one point in his or her life.  A foot goes to sleep, or feet ache after a long run.  Sharp pain can be felt in your heel when you stand up.  These are things we expect and easily shrug off as part of the daily grind our feet endure. However, what about when the pain just won’t go away, or when it becomes chronic?  That’s the kind of pain that shouldn’t be ignored. 

As a rule, feet endure a lot of strain. The way the bones and joints are shaped and the amount of motion there is, provide for shock absorption and flexibility and support. With an ideal foot, biomechanically, the feet work efficiently for hours without pain.  Many people however have feet with too much flexibility, or not enough.  Then the muscles in the feet and legs work overtime, the joints become strained and overall aching and pain result.  Natural shock absorbing bursa sacs can become inflamed as well as other parts of the foot.  On the bottom of the heel, there is a bursa as well as the attachment of the plantar fascia, which is a ligament extending from the heel and fanning out to the ball of the foot.

PLANTAR FASCIITIS/ HEEL PAIN
This condition is caused when the plantar fascia that runs from the base of the toes to the heel becomes inflamed where it connects to the base of the heel.  A large percentage of heel pain sufferers are eventually cured or their pain is managed with non-surgical treatments such as custom orthotics, steroid injections and stretching devices.   Still there are an estimated 50,000 heel pain patients that require surgical intervention every year in the United States. Heel pain surgery has been performed with good results since the early 1990s.  The endoscopic techniques were introduced that allowed surgeons to “release” the desired one-third to two-thirds of the plantar fascia with the aid of a tiny camera by using two small incisions that allow the camera and instruments to pass through the bottom of the heel.

MORTON’S NEUROMA
The symptoms of a Morton’s neuroma are pain and numbness in a specific spot in the ball of the foot, sometimes extending into the toes.  At times the pain may be absent and, at other times, severe enough to cause the person to stop and take off the shoe.  The condition tends to get worse with time and can be a very debilitating disorder.  The enlargement of the nerve is caused by repeated injury.  The nerve becomes trapped or pinched between the metatarsal joints when walking.  This most often occurs in a shoe with a tight toe region, high or very flat heeled shoe or thin, hard sole.  The location is specific to the area between the third and fourth toes but the entire ball of the foot will hurt. Morton’s neuroma is caused when the nerve that runs between the metatarsal heads at the base of the patient’s toes begins to enlarge.  This area, called the interspace, is compressed when the enlarged nerve presses against the underside of the transverse metatarsal ligament that connects to each side of the metatarsal heads at the base of the toes. While conservative treatments can sometimes relieve the symptoms, a large percentage of patients require surgical intervention.  In those people that require surgery, surgeons have previously elected to remove a section of the nerve itself to relieve the patient’s pain. This involves an incision on the top or bottom of the foot, and removal of the section of the nerve that is painful.   The problem is that removing a section of the nerve causes loss of sensation to a portion of the forefoot and adjacent sides of two toes.  Additionally, there is the potential complication of a stump neuroma that can occur if the severed edges of the nerve enlarge. Although, in truth, this procedure has helped many people and is considered successful.  Now there is a new approach that has a much faster recovery, does not remove the nerve, and leaves no visible scar.  The enlarged nerve is decompressed by isolating and releasing the ligament above the nerve.  The nerve is relieved of the pressure from the metatarsal heads, which eliminates the painful symptoms.  The nerve is left intact with no loss of sensation.  There is also a short recovery period without the complications associated with removal of the nerve.  This is a very safe procedure with a high success rate.  Studies presented at the annual meeting of the American Podiatric Medical Association related the efficacy of the Isogard system to be 95.2% for resolved and improved results. And most people are interested in the cosmetic feature of not having a visible scar since the very small incision is made under the toe space.

Bunions
A bunion is the result of gradual movement of the big toe towards the second toe.  Changes occur in the big toe joint and a “bump” forms on the side of the foot.  The condition is painful when the joint goes out of alignment and toe does not move smoothly.  This joint plays a very important role in normal walking.  Part of the joint surface actually becomes rubbed away, just as improper alignment of a car’s wheels causes uneven wear and premature aging of the tires.  Often, due to pain on motion from stiffness of the joint, a person compensates by altering her walking patter.  This causes secondary problems in the knees, hips and lower back.

A second reason that a bunion causes pain is due to a fluid-filled sac, called a bursa, that often forms over the bump.  This bursa, formed by the body to relieve friction in the area, fills with the by-products of the inflammatory response and becomes, itself, a source of pain.   The patient also experiences foot and leg fatigue.  Appreciation of the cause of the bunion is important in assuring that the treatment is correct and long lasting.  Straightening the great toe and removing the bunion helps prevent arthritis in the toe joint.  If the person’s feet need help to maintain good alignment, a shoe insert called an orthotics can be made especially for that person’s feet.  Often confused with store bought orthotics or arch supports, custom orthoses can make a world of difference in a person’s posture and walking.

DR. DEBRA YOUNG IS CONCERNED WITH THE INDIVIDUAL. 
“Nothing makes me happier than when a patient is relieved of their pain.  Foot problems really can affect your daily activities.  We all want to be able to be active, to work and play.  Knowing that your feet hurt changes your plans, your mood.”    Dr. Young has practiced podiatry for many years and is board certified in foot surgery. She is a diplomat of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons.  “It is important to stay current with the modern techniques in both surgery and non surgical foot care. I am trained in the best treatments available while always remembering that time proven treatments are also valuable.”  Just as there are different kinds of people and foot problems, there are many treatment options that can be offered in most situations.  Dr. Young gets much personal satisfaction when she sees a smile on a patient’s face or hears someone say that they thought they would have to live with their pain forever and are happy they found relief.  Her practice philosophy is a positive one and her office reflects that. 

Located at 550 Webster, Suite 304, appointments can be made by calling (773) 871-3338.