I guess it’s the training I received combined with a dry sense of humor and no nonsense approach that filled my practice with patients other doctors considered too hard to heal.  Because of the level of patient I treat at Desert Foot Surgeons, I take your recovery seriously as should you.  The most prefect surgery can still hurt, swell, and even go horribly wrong if you’re not on the same page as your doctor.  I have many patients who can run a mile in under 6 minutes, but their recovery might not be as fast as a patient who smokes.  If we work together, even patients with diabetes who have sores on their feet can heal.

With that said, recovering from hammertoe surgery is usually not that hard.  You should do a few thins to make sure that your healing experience is the most pleasant possible.  Before your surgery is the most important time.  The more you can do for yourself before surgery, the happier you will be after.  Simple things like preparing meals before hand, practicing walking in your special shoe or boot, and planning for time spent resting your foot.

What room in your home worries me most?

Believe it or not it’s your kitchen.  Those kitchen cabinets have that little ledge at the bottom.  Be careful not to hit your toes against this edge.  The shoe or boot you will be wearing is higher than regular shoes and has grabbed hold of more than one of my patients’ bandages.  That’s a good reason to prepare meals before your surgery, but the real reason is you are recovering from surgery.  You shouldn’t have to cook for yourself.  Give yourself at least a little few meals off to rest and stay off your foot.

Since we’re talking about hammertoe surgery most of you will be allowed to walk, but in a special shoe or boot.  You might not think this is going to be hard, but if you’re weak this can be a challenge.  I can send you to physical therapy before the surgery to be sure you can handle the shoe or boot.  This way you and I know exactly what to expect after surgery.  I can even prescribe a strengthening program for you through physical therapy if you need.

Easier Hammertoe Recovery

Other things that can make your recovery from hammertoe surgery easier include getting your house set.  Firsts of all, do you have stairs?  If walking on flat floors is hard in the shoe or boot, stairs might be impossible.  You might want to sleep downstairs the first few days.  You will need to clear a path to the bathroom.  Think about removing area rugs that can slip and slide out from under foot.  Small tables and chairs can have legs that stick out, which could bump your toe.  Think about the ways you can set up your house to help you recover.  My staff has many more ideas that they will be glad to share with you.

Before surgery we developed a plan to help you heal as fast as possible.  After your surgery you need to stick to the plan.  The game plan we designed together before surgery will be given to you in writing.  Obviously there will be a special shoe or boot and pain medication that you should have before you get to the hospital.  That leaves swelling and pain to discuss.  A toe is small and there is not much room for swelling.  The more your foot is down, the more it will swell.  Since there is so little space in the toe this swelling can hurt.  Both of us want your surgery to be as free of pain as possible.  You will need to rest with your foot up.  That means lie flat on the couch or bed and put your feet on pillows.  Make sure your knees are bent a little so this is more comfortable.  Ice can go behind your knee or at the inside of your ankle to prevent swelling.  The ice should be on 20 minutes and then off for 40 minutes.  This can be repeated as often as needed, but usually no less than 3 times per day for the first 3 days.

I like to prepare before surgery as much as possible.  I tell my residents to review a surgery in their mind 5 times before they even step into the operating room.  If your surgeon prepares before surgery shouldn’t you?  I hope this information shows you how Desert Foot Surgeons helps you heal after hammertoe surgery.  Remember, feet are like snowflakes, no 2 are alike.  Choosing your foot surgeon is very important.  Your surgeon needs to have the training and artistic talent to fix your toe.  Equally as important is your ability to communicate with your surgeon.  Ask questions and prepare before your surgery.  You’ll be glad you did.

So you’re at the point where you need surgery to fix your hammertoes and you want more information.  They way I fix your toe depends on the cause and there are 3 causes of hammertoes.  These different causes make the toes bend and twist in different directions.  Your 2nd and 3rd toes will bend in a straight line, but your 4th and 5th toes twist as they bend so the nail doesn’t sit on top of the toe any more.  Just to clarify, your little toe is #5 and your big toe is #1.  Counting from your big toe to the little toe goes 1, 2, 3, 4, and 5.

Let’s start with your 4th and 5th toes.  Unfortunately shoes press the hardest on your 4th and 5th toes.  Because of this constant pressure I can’t make these toes stiff or you would never wear shoes again without pain.  In fact, your 4th and 5th toes are fixed by removing the crooked joint and leaving the toe flexible.  Removing the joint will fix the bend, but does nothing to fix the twisting so I have to use a carefully planned skin incision to un-twist your toe and bring the nail back on top.  The bandages will help to hold your toe in this position since there are no screws or pins, so it is very important that you do not remove your bandages.  To prevent the tendons from pulling on your toe you must wear a special shoe or boot.  You will be allowed to walk after the surgery as long as you wear this shoe or boot, but remember that the more time you spend walking around on your foot after surgery the worse the swelling and pain will be.  Stitches are removed after 10 days and you will wear a loose fitting tennis shoe before you return to tighter shoes.  I expect swelling to last 3-6 weeks, but a lot of that depends on your body.

Your 2nd and 3rd toes are more complicated to fix than the 4th and 5th because they buckle for a different reason.  Because of this difference I have to treat these toes using another approach.  Your 2nd and 3rd toes must be made stiff so that the muscles won’t cause the toe to buckle again after it has been fixed by surgery.  That means that after the surgery your 2nd and 3rd toes will not bend at the toe joint.  You will have a screw or pin in your toe to hold the bones straight.  The screw or pin can be removed in the office at a later date if needed.  No doubt you have heard stories about people having pins sticking out of their toes after hammertoe surgery.  I use newer technology when I can so that you won’t have anything sticking out of your toe.  It is still important that you not change the first set of bandages after surgery.  In straightening your 2nd and 3rd toes I am removing the crooked joint and making the bone ends heal together.  You will be able to walk using special cast boot, but again the amount you walk determines how much swelling and pain you get.  The bone takes about 1 month to heal.  Tennis shoes are easier to wear at first and as swelling and pain subside you can progress to the shoes you want, within reason.

That’s the scoop on the most common hammertoe surgeries.  I’ve told you how fixing your 4th and 5th toes are different from your 2nd and 3rd.  You have an idea of what to expect after surgery.  I have not told you about the more complex toe problems, but will in future posts.  For now remember what I always say, “feet are like snowflakes, no two are alike”.  The surgical approach from one foot to another has to be different, that’s the art of surgery and is one of the main things separating me from other foot surgeons you might meet.

You probably don’t even think about them unless you lose one in the wash.  They are left balled up in a drawer.  Half asleep, you reach in blindly and grab the first pair you make contact with.  You give more consideration to them when you use them for dusting rather than when you wear them.

Socks!  What other particle of clothing has so many uses?  They help to keep your feet clean, warm, and dry, fight dry skin, cushion and protect your soles.  Some people use them as a form of expression and others just an accessory.  Even when they are worn out and no longer suitable for your feet you can use them to polish furniture, shine shoes, wash your car, cover your golf clubs, or make a puppet.

At Desert Foot Surgeons, our talk about socks is not limited to just patients with diabetes.  Socks can make a difference and help in your treatment.  Dr. Geller talks about the fibers used to make the sock, thickness of the material and padding.

The fibers used to make socks are either natural fibers or man-made (acrylic).  Natural fibers are cotton and wool.  You didn’t have to grow up in New Jersey, like Dr. Geller, to know that wool is itchy.  Socks made of cotton and wool are criticized for being too tight and the seams too rough, in other words uncomfortable.  When it comes to keeping your feet dry, natural fibers are not as good as man-made materials.

Acrylic materials are combinations of polyester, nylon, and elastic fibers.  When these types of socks are made with increased cushioning, they are better at keeping moisture away from your skin compared to natural fibers.  The material is softer and the seams easily hidden.  Padded socks made of man-made materials have been shown to lower the pressure on your feet.  Elastic can be increased so that the socks can be used to help prevent swelling.

No matter what material they are made from socks cannot replace shoes.  Walking in socks does not provide the support or protection that a shoe does.  Especially for those of you who have diabetes with loss of feeling in your feet, you cannot walk inside or outside in socks alone.

At Desert Foot Surgeons, Dr. Geller does the shopping for you.  We carry special diabetic socks.  These are high quality, padded acrylic socks especially good for our patients with diabetes.  Even if you don’t have diabetes, these socks are good for people who are athletic or work in areas where your feet are exposed to moisture.  Please give your socks the consideration they deserve and dress your feet.

“I take longer to heal because I have Diabetes”.

This is a statement many patients coming to see Dr. Geller at Desert Foot Surgeons say their first visit. Unfortunately this is a rumor that makes a convenient excuse. When diabetes is controlled you not only reduce your risk of complications such as heart disease, blindness, and kidney failure, but you heal like anyone else.

One out of ten people you meet in the United States has diabetes. Out of the people you know with diabetes, at least one has developed a hole in their skin known as a foot ulcer. The feet are most affected by loss of feeling and circulation. Diabetic foot ulcers are caused by one or both of these complications. What prolongs healing is poor circulation to your legs and feet or walking on an open sore because there is no pain.

Dr. Geller has a special interest in wound healing. At Desert Foot Surgeons we don’t wait for wounds to heal. Wounds are made to heal by fixing poor circulation, getting your weight off of the wound using total contact casting, and even surgery to correct buckled toes, lumps on feet, or skin grafts to cover the defect. Control of your diabetes and compliance with the plan of care is the patient’s role. Healing diabetic foot ulcerations takes a team and the patient is the major player.

If you have a diabetic foot ulcer and have been told you can’t heal because you have diabetes, come and see Dr. Geller at Desert Foot Surgeons.

Before And After Pictures,

(After)

Before Pictures :
WARNING – Click Here for Graphic Images – WARNING

Eli Manning Gets Good Advice For Heel Pain

On October 5th Eli Manning, the quarterback for the New york Giants, was diagnosed with plantar fasciitis after limping off the field in the 4th quarter the day before.  In the NFL pregame show October 18th the treatment for Eli’s condition was discussed.  On the advice of an old football coach he is wearing cowboy boots during the day, using plantar fascia night splints, and wearing custom foot orthotics in his cleats.

Think about this, Eli Manning, a world champion quarterback, franchise quarterback for the New York Giants, brother of Peyton Manning and son of Archie Manning, has possibly the best medical care available second only to the president of the United States, but he is taking the advice of a former coach. Why? One simple reason, the advice is good!

Plantar fasciitis is an overuse injury resulting in heel and arch pain. Wearing cowboy boots takes the strain off of the plantar fascia. Dr. Geller always says, “You can’t begin to heal until the inflammation has gone away”. Taking the stress off the Achilles tendon by wearing cowboy boots plus the physical therapy the Giants training staff is providing for Eli is doing just that.

At Desert Foot Surgeons we often use splints at night. The plantar fascia night splint keeps the Achilles tendon and plantar fascia stretched while you sleep. If you get the severe sharp pains when you get out of bed in the morning this is what night splints are used for. If you can get rid of that morning “zinger” your day will be better.

The overuse part of Eli’s injury and anyone’s plantar fasciitis involves pronation or lowering of the arch. To review pronation is the normal shock absorbing motion of the foot. The foot rolls to the inside, the arch lowers and the heel turns out. This is good, we want to be able to absorb shock when we walk and run. Of course too much of a good thing is bad. When your arch is still lowering at a time when it should be stable is bad and leads to injury. Custom molded foot orthotics prevent abnormal flattening of the arch and heal the plantar fasciitis. Dr. Geller uses video gait analysis and a detailed examination to make the perfect custom molded foot orthotic that will keep your foot stable when walking.

Below are stretching and icing instructions Desert Foot Surgeons has available for patients with plantar fasciitis. Hopefully Eli won’t find this website before the Giants play the Cardinals.

When I was in college I ran 12 miles a day. This was Boulder, Colorado so summer days always had about an hour of rain at 4pm and then everything would cool off. I enjoy running in the rain so scheduled my runs during this little drizzle. After a month of wonderful, calming runs I developed itching between my toes and a red rash with cracking skin in the crease under my little toes. The burning from the cracked skin was intense at times and the itching nearly drove me insane. Have you ever seen this before?

Athlete’s foot is an infection of the skin caused by fungus. Besides redness, itching, burning, and cracking skin, as I experienced, there can be blisters and oozing. If left untreated the infection worsens. The toenails can become infected causing thick and discolored toenails, but that’s a topic for another day. The fungus can decrease your skin’s defenses leading to infection with bacteria noticed by swelling, redness, and more severe pain.

Treatment of fungus begins by removing the source of the infection. Fungus grows in dark, moist places. Can you figure out what I was doing wrong? In my case I was wearing wet shoes everyday to run. Shoes take 24 hours to dry so alternate your shoes everyday. That means don’t wear the same pair of shoes two days in a row. Always wear clean and dry socks, wash your feet thoroughly and make sure you dry between your toes.

Other treatments for fungus are readily available at your store. Medications are usually creams, powders, sprays, gels, or solutions. The antifungal medicine needs to be applied twice each day for about one week. Beware of using creams. If the infection is mostly between your toes creams might keep the area too moist and fail to kill the fungus. Try powders, sprays, or solution between the toes. If you don’t improve after a week you need to see a physician.

Do you have young boys with stinky feet? Look more closely at their feet. Many times a parent brings in a young teen with redness, blisters, scaling and cracking skin, and the overall complaint of “stinky feet”. Dr. Geller has treated many children with pills to kill the fungus infection besides using creams or powders, clean dry socks, and changing shoes. Some people think treating fungus with oral medicine causes liver damage. They are referring to older medicines not used today. The newer pills to treat fungus are safe if prescribed by an experienced physician. Dr. Geller used pills to treat a fungus infection in his son.

Do not delay treatment of athlete’s foot. Bacterial infections are much more painful and challenging to treat. The earlier you are seen the easier the treatment.

Dr. Stephen Geller, AZ Podiatrist

Of adults over 40 years of age in the United States, about 4.5% have peripheral arterial disease (PAD). This is a lack of circulation to your legs and feet.  Healing an ulceration where there is a lack of circulation is very challenging for you and your doctor.  The most important part of healing these open sores is bringing blood into the foot.  Dr. Geller works with vascular surgeons, interventional cardiologists and radiologists who can help with this part of your care.  The actual care of the open wound is determined by Dr. Geller.  This will involve something to keep pressure off the sore and medication applied to the wound.  At Desert Foot Surgeons you will find a physician with the expertise and experience needed to develop a program that best suits your needs.

Those of you who have healed an arterial ulceration have suffered a great deal of pain and possibly even undergone surgical correction of the poor artery circulation.  If this is not enough reason to quit smoking I don’t know what is. Part of your recovery will be walking for exercise to increase circulation even if you had surgery. Since most arterial ulcerations are on the feet you will need protection of the scar by shoes and possibly inserts. Your heels may need to be protected while lying in bed. Moisturizing dry skin using specific foot creams is also recommended to help prevent new or recurrent ulcerations.

Dr. Stephen Geller, AZ Podiatrist

The big toe can develop a lump or bump on the inside of the foot. This prominence initially becomes painful in shoes from pressure, but if left untreated arthritis will set in. The lump on the inside of the foot at the base of the great toe is called a bunion. Often mistakenly referred to as a growth of bone, the cause of a bunion is really the result of an unstable joint. The loss of stability in the big toe joint causes the bone behind the big toe to drift inward leading to the lump or bump. The more the bone drifts, the more your big toe falls toward the second toe.

How the joint becomes unstable is related to the way your foot hits the ground when you walk. A detailed examination of your feet while standing and walking is needed to determine why your foot is unstable. If caught early custom molded foot orthoses can restore stability to the joint and prevent further damage.

If painful, damage to the joint has already occurred. Custom molded foot orthoses will restore stability to the joint, which can improve pain, but usually therapy involving anti-inflammatory medication is needed as well. When pain does not respond to stabilizing the foot, surgery is needed. The goal of surgery is to provide stability to the joint from within preventing further damage. This is accomplished by moving the bone that has shifted back into line with the big toe. The more the bone needs to be shifted, the longer the recovery. So getting treatment early is always recommended.

Dr. Stephen Geller, DPM , AZ Podiatrist

Swelling in the legs can be caused by bad veins with valves that no longer work, injury from prior blood clot or phlebitis, weak muscles that pump the blood up the leg, or increased pressure in other organs such as your heart.

In order to heal your wound you were placed in some form of compression wrap. Once your scar was mature enough to handle pressure from socks you were prescribed support hose. Even though we live in Phoenix where temperatures often exceed 100ºF the compression is needed to fight the swelling. Surgery is often used for bad veins, but even so support hose are a required part of this treatment. There is no way around it, you will have to wear some form of compression garment.

Dr. Stephen Geller, AZ Podiatrist

Toes that are bent or buckled hurt when you put them into shoes. Parts of the toe can rub against shoes making areas of hard skin, known as corns. These can be reduced by your podiatrist, but will never resolve unless the toe is straightened. Changing the shoe to keep pressure off the toes might not be possible depending on how severe the toe is buckled.

The treatment differs based on the stiffness of the bent toe. Smaller toes such as the 4th or 5th that can be straightened by hand often can be treated by simple tendon release. This is the easiest hammertoe surgery to recovery from often requiring a single stitch. If more than one toe is done at a time the recovery can be slightly longer.

If the bend in the toe cannot be straightened by hand, removal of the rigid joint is performed. At Geller Podiatry we employ a detailed step-wise approach to straighten all parts of the toe. The more deformed the toe, the more steps will be used from simply fusing the toe joint straight to breaking the metatarsal head and repositioning the entire toe. Tight skin has to be lengthened using plastic surgery techniques so that the toe can stay straight and the scar is more cosmetic. In general these procedures require protection from walking using a cast boot. X-rays are used to follow the toe healing process and you will be returned to shoes when your doctor sees evidence of bone healing.

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