It’s easy to take healthy, functioning feet for granted. However, the odds
are that at some point you will be affected by a foot or ankle ailment.
“Recent studies have shown that four out of five people will have a foot
ailment during their life,” says Bob Baravarian, chief of podiatric surgery at
Santa Monica-UCLA Medical Center and director of the Foot and Ankle Institute in
Los Angeles.
Smart Business spoke with Baravarian about foot and ankle problems,
when podiatric surgery is the optimal course of action and how surgery has
advanced over the past 10 years.
What are the most common foot and ankle problems?
The most common problems that we see are ankle or foot sprains, which are
probably the most common sports-related injuries in any part of the body. Other
common problems are heel pain, or plantar fasciitis, bunion or hammertoe
deformities, neuromas and tendonitis. The causes can be anything from overuse
injuries to fractures, tendon tears or nerve irritation.
How can foot and ankle problems be avoided?
The simplest and most common thing that is not done well, is stretching
adequately. The main area to stretch is the Achilles tendon. When the Achilles
is tight, a lot more strain is put on the foot during every step of walking.
It’s also important to wear the proper type of shoes. It’s not that a certain
shoe causes a bunion or hammertoe — those are genetic conditions — but if a
person wears tight shoes and has a predisposition toward a certain foot ailment,
this could cause a problem. The shoes should also be adequate as far as the type
of activity you’re engaged in. For example, if you’re playing basketball, you
shouldn’t play with running shoes on.
When is surgery required for foot and ankle ailments?
Seventy percent of the things we see respond to conservative treatment such
as making a special insole for the shoe, physical therapy or injections. We
might suggest surgery as a first-line treatment if someone came in with a
fracture that was displaced or for someone with an acute tendon tear.
How should a person decide if surgery is the most viable option?
Many times we will talk to a patient about getting another opinion. This is
something that patients should be very comfortable with. No doctor should feel
like he or she is getting his or her feelings hurt.
Patients need to make sure that what is being done is proper. Also, they have
to remember that there are 20 ways of doing the same thing. Out of those 20
ways, maybe two or three will work for them. So it’s not that there is one gold
standard; you have to find out which one is the best suited to what you need.
You have to be very confident in your doctor, and you should do some research
about what your problem is and what the reasoning behind the surgery is.
How can patients hasten their recovery following surgery?
The most important thing is to follow the instructions given to them to a T.
What usually causes problems is when patients try to push the envelope for
recovery and end up pushing so hard that they actually damage the surgical
procedure. If bone work is being done, there are some external bone stimulators
that can be used to heal bones faster.
What advancements have been made in podiatric surgery over the past
decade?
The level of training for foot and ankle surgeons has dramatically changed in
the past 10 years. There have been advances in the techniques that are done and
the equipment that is used. Better diagnostic tools allow us to better treat
patients.
The concept of arthroscopy; that is, being able to put a camera into a joint
and cleaning up the joint without making big incisions, is a significant
advancement. We’re now using this in multiple joints in the foot and ankle, not
only for diagnostic purposes, but also for treatment purposes.
Bunion surgery has changed dramatically, because instead of cutting the bone
and hoping it stays where you put it, we’re now using screws to hold the bone
together.
There are a lot of new techniques in nerve surgery. In the past, diabetic
patients who had nerve issues would usually be told there was nothing that could
be done for them. Now, we are able to free up the nerves in diabetic patients
and they have very good results.
BOB BARAVARIAN is chief of podiatric surgery at Santa Monica-UCLA
Medical Center and director of the Foot and Ankle Institute in Los Angeles.
Reach him at (310) 828-0011 or bbaravarian@mednet.ucla.edu. For more information
about the Foot and Ankle Institute visit www.footankleinstitute.com.
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