Tuesday, November 12, 2013

Types of Bunion Procedures and Terminology

You might hear different terms used to describe a bunion surgery. Depending on the severity of the bunion, a more complicated procedure might be needed.

A Cheilectomy is a term used to describe just shaving the bump. It can also involve shaving around the joint to make things more rounded. In this procedure no hardware is need and it allows for the quickest healing time.

If the bunion is more severe, a cheilectomy alone is not appropriate because it has a high chance of recurrence. With most bunion surgeries a cheilectomy will be done on top of the described procedure.

The next common bunion procedure done is a Chevron osteotomy, also known and an Austin or and Kalish. This is a "V" type of cut in the 1st metatarsal to slide it over. Once the bone is slid over screws are used as fixation. The screws stay in forever usually. They do not set off any alarms at the airport. Rarely the screws need to come out.

An Akin procedure is an osteotomy of the big toe, hallux. Sometimes in order to make everything sit straight the big toe must also be corrected.

When closing the surgical site repair of the capsule and ligaments is done to help hold things in alignment.

Moving further back there is a Scarf type of bunionectomy also known as a "Z" type osteotomy. This will also be held with screws.

A closing or open base wedge osteotomy is done even closer to the base of the metatarsal for more of the severe bunions. This procedure is held with a plate and screw or just screws.

Finally there is the Lapidus bunionectomy that involves fusion of the 1st metatarsal-cuneiform joint. This is done for patients with severe bunions and those patients who have ligamentous laxity. This procedure usually requires screw and plate fixation. It is one of the more complicated bunion procedures due to technical components. It will usually require limited walking along with a period of possible non weight bearing.

For a surgical consult on bunions please feel free to contact Dr. Gennady Kolodenker (949) 651-1202.

Bunion Surgery Specialist in Orange County - Southern California - Irvine - Newport Beach

Wednesday, October 16, 2013

Laser Treatment for Toe Nail Fungus in Orange County - Laser Nail Fungus Treatment Orange County

We offer laser fungal toe nail treatment at a greatly reduced cost
The treatment will be offered on scheduled days. Schedule your appointment soon, we tend to fill up.
Contact our office in Orange County for an appointment.
(949) 651-1202

How can we offer toe nail laser fungus treatment for such a low price?


We will be doing the treatment only one weekend per month. We are able to rent the device for a competative cost and pass on the savings to our patients

What is Toe Nail Fungus?


The medical term for toe nail fungus is Onychomycosis. When fungus gets under the toe nail it feeds off the keratin. As the fungus grows the nail will become yellowed, thickened, discolored, dystrophic and possibly ingrown. Frequently the fungal toe nail will feel painful due to the thickness.

Where does nail fungus come from?


There is fungus all around us. There is no good medical explanation of why some people develop toe nail fungus, Onychomycosis. There is usually a traumatic incident that causes the nail to lift up slightly. Once the nail is elevated off of the bed the fungus begins to colonize.

What are the treatment options for Nail Fungus?


The treatment options for nail fungus range from topical medication, oral medication and Laser Therapy. Topical medications need to be used for the growth cycle of the nail. The nail typically takes anywhere from 6-10 months to fully grow out.

Various topical medication to treat and kill toe nail fungus can be purchased online.


Another option for treatment is oral medication. Prior to starting oral medication treatment a blood test should be perform to evaluate the function of Liver. Medication is taken for a total of 12 weeks, one pill per day. At about 6 weeks the blood test should be repeated to evaluate the Liver function. There is a very small chance of Liver damage. Success of oral fungal nail treatment is around 70%-80%.

Finally, Laser Nail Treatment is a revolutionary toe nail fungus treatment that is safe and successful. Success rate for laser nail treatment range from 70%-80%.

Does the Laser Fungus Nail Treatment Work?

Yes. The Cutera Genesis Plus Laser is safe and effective in the treatment of onychomycosis.

Will I see instant results after Laser Fungus Nail Treatment?

No. It takes the toe nail an average of 6-10 months to grow out. While the nail is growing you should start to see a clearing at the base. Sometimes multiple treatments are needed.

Does the Laser Fungus Nail Treatment Hurt?

No. The treatment takes about 5 minutes per toe. The nail starts to feel warm. There is a temperature monitor on the laser.

What is the Cost of Treatment?

Cost depends on the numer of toes and feet done.

Does Insurance Cover the Laser Treatment?


No. Unfortunately most insurance plans will not pay for laser nail fungus treatment.

What Should I do After Treatment?


Use an Ultraviolet Light to eradicate and kill toe nail fungus in your shoes or it will re-infect your feet and toes nails.




Some patients require a second laser therapy treatment 6 months after the first. There is no extra laser cost if a second laser therapy procedure needs to be done.



Monday, April 8, 2013

Finding a Bunion Surgeon in Southern California

It is sometimes difficulty to figure out if you are picking the correct surgeon in Southern California.

How do you start the search process for a Bunion Surgeon?

There are lots of websites that can help guide you.

Yelp has lots of reviews of Doctors.

Go online to the Podiatry Medical Board and look to see if your doctor has any sanctions or is on probation.

In the end you need to feel comfortable with your doctor.

For any further questions feel free to contact me. Dr. Gennady Kolodenker, DPM

Bunion Surgery Specialist in Southern California.

(949) 651-1202

Thursday, March 28, 2013

Ingrown Toe Nail Treatment - Common Mistake

Very frequently I will see patients that come in to the office because they have an ingrown toe nail and the pain has been present for several days or weeks.

The patient may have been seen at an urgent care center, primary care office or pediatrician. The treatment rendered was a course of antibiotics. Possibly soaking.

The patient presents with continued pain, swelling, redness and draining fluid (pus).

So what is the mistake?

Treating an ingrown nail with antibiotic alone is a poor choice.

Removing the ingrown nail border will correct the problem. In 99% of patients an antibiotic is not even needed.

With growing antibiotic resistance save the the medication for a time that is really needed.

For an Ingrown Toe nail procedure contact Dr. Kolodenker in Orange County California.

4950 Barranca Pkwy
Suite 308
Irvine, CA 92604
(949) 651-1202
(949) 552-9493 - fax


Wednesday, March 6, 2013

How to create a bi-lobed flap in the foot

How to create a bi-lobed flap in the foot


A bi lobed flap is very useful when surgically removing a large soft tissue mass, a tumor or a wart.

The following images are for surgical education purposes and training only.

The first image is of a large soft tissue mass that turned out to be a plantar verrucae. The lesion was taken out by another doctor and returned to grow much larger when the patient presented in my foot and ankle clinic. The advantage of placing a flap is primary closure of the surgical site.




The first part of creating a bi lobed flap is surgical planning. It is vital to know anatomy and skin tension lines. 

Pearl: I would advise not to place any local medication under the surgical site. An ankle block or general anesthesia is best. Local anesthetic will place too much tension on the skin and make it difficult to rotate the flap. 



Second Pearl: The width of flap B should be about the same as the soft tissue mass (C). The width of flap A should be about 40% smaller than flap B


In the above picture the relationship of the bi-lobed flap is 90 degrees (Black Lines). I would advise to make the flap relation around 80-65 degrees. 

Index:
A: Used to close flap defect
B: Used to close the soft tissue defect
C: Soft tissue mass

Step 1: Draw a circle around the soft tissue mass and make sure to take a clear margin.
Step 2: From the opposite corners of the circle create a cone. In the above picture the cone is made of one red line and one black line.The point of the cone is pointed up in the above picture. 
Step 3: Draw a 90 degree line from the red line- two lines should be about the same length
Step 4: Draw a 80-65 degree line from the black line - two lines should be about the same length



Make a full thickness incision. Undermine the entire flap. Undermine the skin around the other side of the incision. Be careful when handling the soft tissue. Be very delicate.
Rotate the entire flap and suture it down.  



Suture the flap down. 
Some areas might look slightly white. As long as the patient has good blood flow the skin color should return to pink. 
Finally, remain off the foot for 3 weeks.

For more information contact Dr. Kolodenker, Foot and Ankle Surgical Podiatrist in Orange County



Thursday, February 28, 2013


Bunionectomy

 

What is a bunion?

A bunion is a bump on the big toe side of the foot and is actually bone. It may be red and painful whether you are walking or resting. The first metatarsal, the large bone located where the toe meets the foot, rotates outward and pushes your big toe inward toward your other toes. This can sometimes cause your toes to overlap, which causes pain.

What causes bunions?

Bunion formation runs in families, so if a parent or other relative has a bunion, you have a higher risk of also developing a bunion. Bunions can be irritated by friction from ill-fitting shoes. Wearing high-heeled shoes puts unwanted pressure on the joints of the forefoot, which can result in painful bunions. Bunions may be caused by a congenital anatomical deformity, flat feet, a tight Achilles tendon, polio, or rheumatoid arthritis. Even if you develop a bunion, it may not progress to the point where it needs surgical correction. Non symptomatic bunions can be managed by appropriate shoe wear.

When choosing shoes, follow these tips:
  • Judge the shoe by how it fits and feels on your foot, not by the size marked on the shoe or the box.
  • Measure your feet regularly as you grow older. Foot size changes with age.
  • Try on shoes late in the day when your feet are at their largest.
  • Do not wear shoes that feel too tight. Do not expect them to stretch.
  • Make sure your heel fits comfortably in the shoe with minimum slippage.
  • Walk around in the shoe to make sure it fits well.

Diagnosing bunions

Diagnosis of bunions is based on physical examination, a complete history of your symptoms, and diagnostic studies. Diagnostic studies help the podiatrist determine the precise nature of the deformity. He or she can determine the extent of the problem with the big toe and how much the second toe is involved. Your podiatrist will assess your standing and walking to determine whether or not your gait is affected. Your range of motion will be tested as well, and a vascular and neurologic assessment will also be made prior to treatment.

Conservative treatment of bunions

Before surgical correction of bunions is undertaken, the podiatrist may treat your bunion with conservative measures.

Conservative treatment modalities include:
  • Activity modification, rest and elevation of the affected foot;
  • Changing to footwear that puts less pressure on the tender area;
  • Soaking the foot in warm water;
  • Anti-inflammatory medications;
  • Steroid injection into the area surrounding the affected joint;
  • Orthotic devices;
  • Using cushioned padding in the shoes;
  • Taping the foot to retain normal positioning;
  • Physical therapy, including ultrasound therapy or whirlpool baths.

Surgical correction of bunions

If nonsurgical treatment is not successful, your podiatrist may suggest surgery. Studies show that 85-90% of patients who have bunion surgery are satisfied with the results. The goal of such surgery is to relieve your pain and correct your foot deformity.

If your bunion causes foot pain that restricts your everyday activities, you may benefit from bunion surgery. Other indications for surgical correction include chronic inflammation that does not improve with rest or medication.

Dr. Gennady Kolodenker is a bunion surgery specialist in Orange County. Irvine, CA

Preparation for surgery

If you decide to have bunion surgery, your podiatrist or your personal physician will assess your general health. You may need preoperative clearance from your primary care or treating physician. Conditions such as diabetes, rheumatoid arthritis, or circulatory difficulties could negatively impact your healing and could increase postoperative pain.

Be sure to tell your podiatrist what medications you take regularly, including herbal or natural remedies. Follow your podiatrist’s instructions on which medications you should or should not stop taking before surgery.

You may or may not be required to have blood tests, cardiac testing, chest X-ray, or urinalysis in addition to foot X-rays or other imaging studies.

The usual surgical outcome

Most patients have a significant decrease in pain after surgery and greatly improved alignment of the big toe. Your outcome will depend on how severe your bunion deformity was before surgery, your medical condition, your age, and your compliance with postoperative instructions. In general, there may be some degree of swelling of the foot for three to six months following surgery.

Your podiatrist will follow you closely during this postoperative period and recommend exercises or physical therapy to improve foot strength and range of motion. Depending on the extent of your condition, you can expect a recovery period of at least six to eight weeks, or longer. During that time you may be required to wear a special shoe or boot, or even a cast to provide stability to the foot. Your doctor will tell you when you can walk on your foot again.

Risks of bunion surgery and potential complications

Even the most minor surgical procedure has a degree of risk. Your podiatrist will go over the most common problems that have occurred after bunion surgery. These include infection, recurrence of pain, nerve damage (which could be chronic), recurrence of the bunion, poor healing, bleeding, scarring, blood clots, or allergic reaction. Most complications are treatable, but may increase your recovery time. Although it is rare, you could experience stroke, heart attack, loss of a limb, or death.

Your podiatrist will go over all these possibilities with you so you have a full picture of what to expect. After he or she has described these potential risks to you, you will be asked to sign a form called an informed consent form. Be sure to ask questions if you are uncertain about what you are being told, and make sure your questions are answered to your satisfaction. Your signature on this form indicates that your questions have been answered and you have been informed of the risks and potential complications of bunion surgery.

Types of bunion surgery

Your podiatrist will determine which type of surgical procedure is right for you. There are many different types of surgical procedures for treating bunions, many of which are named after the doctors who developed them. Examples of these are Keller bunionectomy, McBride technique, and Austin osteotomy. Ask your doctor to explain the type of procedure he or she feels is best for you.

Many bunion surgical procedures are done as outpatients. You will be asked to arrive at the outpatient facility one to two hours before the surgery, and can usually go home an hour or two after the surgery. The procedure itself will take about one hour.

The type of anesthesia used will depend on the type of surgery done, your condition, and the anticipated length of the surgery. Most bunionectomies are done with a local anesthetic agent to numb the area. In some cases you may have general anesthesia. After surgery you will go to the recovery room. You will have one or more scars after the surgery, depending on the type of surgery performed.

Postoperative recovery

It is important that you follow your podiatrist’s instructions completely following the surgery. You will be following up with visits to your podiatrist regularly for several months after your surgery.

You should call the office immediately if you notice any of the following:
  • Fever of 101oF or higher and/or chills;
  • Persistent, uncomfortable warmth or redness around the dressing;
  • Persistent or unbearable pain;
  • Bloody drainage;
  • Nausea and/or vomiting;
  • Pain, redness, or swelling in one or both legs;
  • Feeling anxious;
  • Chest pain, shortness of breath, or coughing.

You will be sent home after surgery with a dressing to hold your toe in the realigned position. You may or may not receive a special surgical shoe to wear for some time. You should notify your podiatrist if your dressing comes off or gets wet, or if you notice blood or other drainage on it. It is very important to leave the dressings in place and not get them wet or dirty. If you have difficulty with your dressings, call your podiatrist.

Postoperative office visits

Ordinarily you will see your podiatrist three or four days after surgery for a dressing change, and postoperative X-rays may be taken at that time. About two weeks after surgery your podiatrist will remove the stitches. Once the stitches are removed, you may be able to bathe normally. Be sure to ask your doctor for instructions.

Your doctor will let you know when you can start to wear shoes, and the best type for you. You should continue to faithfully do the exercises your podiatrist has given you. Apply skin emollients, such as aloe vera or vitamin E, around the healing wound as directed. Your doctor will instruct you on when you can walk, drive, and resume other activities.

The postoperative course varies for individuals. For some patients, swelling may last longer and healing may take more time than anticipated. You should try to keep your foot elevated as much as possible immediately after the surgery. Your doctor may instruct you to apply ice to your foot. If so, ask him or her to provide you with specific instructions on how to do this. You could experience some swelling in your foot for several months following the surgery. Contact your doctor if you have questions about your swelling.

Exercise

Be sure to engage in the exercises your podiatrist recommends. These exercises will help restore your range of motion and your foot strength. Do not engage in any strenuous or weightbearing exercises that are not recommended by your podiatrist. 

This Bunionectomy Patient Education Tool was developed by Data Trace Publishing Company.


Monday, January 28, 2013

How to pick the correct ankle brace

There are so many ankle braces on the market it is difficult to know which brace to pick.

I will go over the advantages and reasoning of choosing a correct ankle support brace.

Ankle braces are typically worn to prevent ankle sprains. The best way to prevent an ankle sprain is to strengthen the ankle via physical therapy. Peroneal tendon strengthening is recommended. The strengthening is done using a Exercise Band.

REP Band Pre-Cut Exercise Pack

An Exercise Board is used to increase preconception and balance, increases range-of-motion, strengthens the lower kinetic chain and is appropriate for use in therapy as well as active training.

 Ankle Exercise Board



Light weight ankle sleeves are used right after an injury to control edema. They are also good for the late stage in recovery. The brace gives your body feedback to pay closer attention to the ankle. Since they are soft it is much easier to move around. The sleeve is less bulky.

 Silipos Malleolar Gel Sleeve 
The Malleolar Gel Sleeve provides mild compression to help reduce swelling in and around the anklebone. Two soft polymer gel pads, molded into the elastic sleeve, comfortably conforms over the ankle to moisturize your skin while they cushion and protect your ankle from abrasion, friction, shear, chafing and callus formation. Washable and reusable, the Malleolar Gel Sleeve can be used to provide an additional protective layer to help prevent injuries. Great for sports use. Easily fits inside shoe, boots and athletic footwear. One size fits left or right ankle.


Silipos Soft Skin Heel Sleeve
Molded with Silipos® proprietary gel pad that conforms to the shape of the heel, the Soft Skin Heel Sleeve™ is designed as a night sleeve to provide moisturization and relief for the dry and hard skin on the heel. The dermatologist-tested gel gradually dissipates a high grade mineral oil to moisturize, soften, soothe, and rejuvenate dry and hard skin at the heel while protecting the heel from friction, abrasion and pressure. The sleeve is fully hand-washable and reusable


Pedifix Compression Anklet

  • Graduated compression from toes to calf assures increased venous activity.
  • Reduces swelling for faster healing and less pain.
  • Soft, lightweight spandex/nylon knit for comfort and patient compliance.
  • Fleshtone color for undetectable wear.


Stromgren Double Strap Ankle Brace


The nylon/lycra sock of the Stromgren Ankle Brace comfortably supports the ankle and the Posterior Tibial Tendon. Additional stability and support is provided with the two attached straps that are wrapped in opposite directions around the ankle, and are held in place with hook and loop fastners.

This is a thin, low bulk brace that will fit in most styles of footwear with a low heel.
Fits either the left or right ankle.


Fabrifoam AnkleGard











  • Durable, supportive design, made of NuStimWrap, resists migration and delivers maximum adjustable compression.
  • Fits securely on either ankle with attached Velcro.
  • Wrap, when applied directly to the skin, will not cause blistering or irritation.
  • Slim design promotes comfortable wear in most footwear.


  •  Elastic Bandages



    The next line of braces are known as the Stirrup Type. These braces will provide more support and a higher degree of inversion prevention. They feel light and allow the ankle to bend up and down in a natural way. Sometimes a half size larger shoe is needed. These braces provide ideal support during the healing process after an ankle sprain injury.

     Formfit Ankle Stirrup with Foam Pads

    Performance Benefits:
    • Patented Form Fit 3 dimensional molded pads
    • Flex-Edges and adjustable pivoting heel straps
    • Lightweight and breathable
    • Quicker application



    Gel Ankle Brace

    Performance Benefits:
    • Safe hot / cold therapy
    • Patented lace-lock feature for added stability
    • Available with 50% surface gel or 80% surface gel


         Active Ankle T2 Ankle Brace

    Features and Benefits:
    • The T2 features a durable, quick-fitting single strap system that is adjustable for both high and low top footwear. his Allows for a better fit.
    • The sturdy medial and lateral fiberglass shell is covered with feather-light EVA padding that hugs and protects every contour of the ankle, offering a sleeker, less bulky brace while still offering maximum performance and protection.
    • The fiberglass shell transfers some of the weight-bearing forces around the injury site up into the lower leg to help reduce pain.
    • Bilateral hinges allow unrestricted flexion of the ankle, while preventing painful and damaging inversion and eversion of the ankle.

    Fits either the right or left foot and ankle, sizing is by footwear size.



     
      AirCast Air-Stirrup® Universe

    Features and Benefits
    • Patented Duplex aircell system to enhance circulation and reduce swelling.
    • Universal semi-rigid shells prevent further injury while allowing normal ambulation.
    • Pre-Inflated aircell and adjustable heel pad for easy fit and maximum comfort.



      Aircast AirLift™  

    Features and Benefits:
    • Adjustable arch aircell for individualized support and comfort
    • Anatomically designed shells for secure ankle stability
    • Rear entry design and simple two strap application promote ease of use and compliance



    The last type of ankle brace is a hybrid type. The hybrid braces typically consist of a strap and lace pattern. They wrap around the ankle giving more control and support than a plain elastic brace. The sides are usually softer allowing for increased comfort. These type of braces are used for a patient who is a higher risk for inversion injury, but still participates in a high energy sport.

    Form Fit Ankle Brace


    Features:
    • Speed laces allow the user to lace up the Exoform in seconds, a big time saver that will encourage use and drive compliance.
    • Slim fit design is low profile and fits easily into all footwear.
    • Injection molded exoskeleton forms a network of support zones strategically placed to minimize inversion and eversion without restricting plantar and dorsi-flexion.
    • Available with a unique heel-lock strapping system.
    • Nylon "figure 8" straps will not stretch during exercise. Fully adjustable even while in use.
    • Breathable lightweight fabric enhances comfort by allowing heat and moisture to escape throughout the brace.
    • Padded heel and tongue fabric is durable and provides added comfort. Material is 100% latex free. 
    • Machine washable, air dries quickly.
    • Bi-lateral design fits left or right ankle.


      Swede-O Inner Lok 8

    Features:
    • Super easy strap adjustment for a comfortable custom fit with solid support.
    • Exclusive internal figure eight straps are pre-configured to assure proper placement and support.
    • Fast and easy application of brace due to pre-configured internal straps.
    • Junior ballistic nylon construction with internal laminated foam provides both strength and comfort.
    • Thinner than conventional braces makes for a more natural and comfortable feel.
    • Breath-O-Prene™ tongue actually wicks moisture away from your skin. This makes the Inner Lok 8 a very comfortable ankle brace.
    • Available in white.
    • Fits either right or left.



       Quick-Tie Ankle Brace

    The Quick-Tie Ankle Brace is made of DermaDry bracing material. The advantages of this material are:
      • It retains soothing warmth in the soft tissues, keeping them flexible, which helps with healing and also helps to prevent further injury.
      • It is lined with KwickWick treated polyester to help evaporate perspiration. This makes it cooler and more comfortable than taping the ankle.
      • Provides just the amount of comfortable compression that you need and want.
        This Ankle Support is durable, comfortable, and easy to apply to the foot and ankle.
        Universal right and left. One size fits all.



        All the above braces can be purchased at the online store.


        Cross Fit

        Organized classes are a great way to stay motivated, get in shape, and be fit.

        With more people joining there is less personal attention from your trainer. 

        Injures in these burst type activity classes are more frequent, even for the experienced athlete.

        Be sure to discuss with your personal trainer any orthopedic injuries or other medical conditions you may have.

        Be aware of body mechanics during the exercise routine.
        Proper technique will decrease the incidence of injury. 

        Commonly seen injuries are ankle sprains, plantar fasciitis, stress fractures, and tendinitis. 

        For more questions contact Dr. Gennady Kolodeneker, DPM, AACFAS.

        Foot and Ankle Sports Medicine Surgical Specialist in Orange County.