Tag Archives: Foot Surgery

Introducing “Walk Away” Bunion Surgery

23 Mar

A zero downtime bunion procedure is now a reality.

PA Foot and Ankle Associates is the first podiatric practice in the Lehigh Valley (and one of only two on the U.S. east coast) to offer a revolutionary new bunion correction procedure called the FastForward System. FastForward offers minimal discomfort, minimal scarring and no downtime for the patient.


Dr. Adam Teichman, Senior Partner at PA Foot and Ankle Associates comments, “We continue to offer innovative approaches to podiatric medicine with the FastForward System. This bunion procedure allows a patient to resume their lifestyle much sooner, and helps to dispel the myth that bunion surgery is painful and requires a patient to be off their feet feet for long time.”

Why is FastForward revolutionary?

A bunion, known medically as a Hallux valgus deformity, is a prevalent and debilitating foot condition that affects 23% of people age 18-65 each year. Prior to the invention of FastForward, a bunion was treated surgically by means of a bunionectomy. This foot surgery used a series of bone cuts and bone screws to realign the first metatarsal – the longest bone in the foot – with the big toe. As cuts to realign bone are by their nature traumatic, bunionectomies require the patient to stay off of their feet for a period of days, followed by a recovery period of 1-2 months. The larger the bunion deformity, the more aggressive the procedure, leading to longer recovery time and downtime for the patient. With the FastForward procedure, a patient can walk immediately after surgery (in a protective shoe) and can be back in a sneaker in 2-3 weeks.

FastForward also eliminates certain painful complications which occur in some bunionectomy patients – namely, intolerance to bone screws or bones which don’t heal correctly. These complications often required a 2nd surgery to correct.

FastForward bunion procedure uses 3D printing technology

The key to this new bunion procedure is the FDA-approved FastForward Bone Tether Plate. The unique design of this medical device, achieved through 3D printing technology, allows an as-close-as-possible match to the anatomy of the second metatarsal (3D printing allows for the fabrication of devices with complex geometries). Working through a tiny incision, the podiatric surgeon anchors the FastForward Bone Tether Plate to the 2nd metatarsal, wraps the 1st and 2nd metatarsals with suture tape, and then safely pulls the bones and big toe into proper alignment. Less drilling and bone cutting means a quicker recovery and less pain for the patient.

Previous bunion correction procedures which pulled the metatarsals into alignment, required drilling into the 2nd metatarsal, subjecting it to significant stress. For some patients, this resulted in fractures of the 2nd metatarsal. The FastForward Bone Tether Plate eliminates that complication, as it conforms to the shape of the bone and requires no drilling of the 2nd metatarsal.

More info on FastForward Bunion Correction

Detroit’s Miguel Cabrera has surgery for bone spurs and stress fracture

27 Oct

cabrera hits a homer

Miguel Cabrera, legendary first baseman for the Detroit Tigers, surprised everyone – or no one at all, depending on who you ask – by announcing that he had right ankle surgery to remove the bone spurs which dogged him all season, and to repair a stress fracture of the navicular bone. The navicular bone lies on the top of the foot near the front of the ankle, and plays an important role in maintaining the arch of the foot.

If you’re a baseball fan, you no doubt heard that Cabrera struggled with these injuries the second half of the season this year, even though he hit .313 with 25 home runs, and 109 RBI’s (that’s a crap season for Cabrera, even though anyone else would be breaking out the Cristal and re-negotiating their contract with those numbers). By comparison, in 2013 Cabrera hit .348 with 44 home runs and 137 RBI’s, which won him his second consecutive American League Most Valuable Player award. By the end of this season however, Cabrera could barely run on the ankle due to the excruciating pain.

navicular bone fracture

Arrow points to the Navicular bone.

“It was a surprise, I’d say, for all of us,” team president Dave Dombrowski said. “We were not aware [the stress fracture] was there. I’m not sure how long it was there. He did have a couple of screws inserted. They cannot even believe once they went in there and looked at it that he could play with the ankle that he had. It’s worse than what we ever would have anticipated.”

Cabrera’s ankle will be reevaluated in 3 months, late in January, just a few weeks before the Tiger’s spring training is to begin.

Tarsal Tunnel Syndrome (TTS) Surgery – Patient Testimonial

18 Sep

Charlene Ninni of Center Valley, PA suffered with excruciating and debilitating pain which would travel from the inside of her ankle, throughout her foot, and sometimes all the way to her hip. For almost 2 years, she sought the advice of a number of orthopedic surgeons, none of whom were successful in relieving her foot and leg pain, or her swollen ankle.

tarsal tunnel syndrome surgery

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle.

The simple things most of us take for granted, like walking up the stairs or food shopping, had become difficult to impossible for Charlene. She had learned to wait as long as possible before doing anything that required walking, and she asked frequently for assistance from friends and family. With one of her ankles all but useless, and in almost constant pain, life had become challenging.

One night at a Lehigh Valley IronPigs game, while paging through that night’s program, she saw an ad for a seminar that Dr. Adam Teichman of PA Foot and Ankle Associates was conducting on foot health. When Charlene showed up at the seminar in the walking boot her most recent orthopedic physician had given her, Dr. Teichman couldn’t help but start a conversation with her. They discussed her symptoms, he ballparked a few possible reasons for her condition, and he recommended she see him for an exam and diagnosis.

After Charlene’s exam in the PA Foot and Ankle Associates office, Dr. Teichman’s diagnosis was tarsal tunnel syndrome. He recommended surgery as the best treatment option to relieve Charlene’s pain. Charlene agreed to the surgery, and today she couldn’t be happier with the outcome.

Watch Charlene’s video testimonial below in which she discusses her symptoms and tells us how great she’s feeling now compared with 2 years ago.

About Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot condition.

The tarsal tunnel is found along the inner leg behind the bump on the inside of the ankle. Through this tunnel passes a collection of arteries, nerves, tendons, and muscles. Inside the tarsal tunnel, the tibial nerve splits into three segments – one segment continues to the heel, and the other two continue to the bottom of the foot.

When the tibial nerve becomes entrapped or “pinched” in the tarsal tunnel due to inflammation or swelling, numbness may be felt in the foot radiating all the way to the big toe and the first 3 toes. Additionally, pain, burning, tingling, and electrical sensations may be felt in the base of the foot, ankle, or heel.

Visit the PA Foot and Ankle Associates website for more information on Tarsal tunnel syndrome.

If you had a choice, would you request an amputation? This guy did.

18 Jul

Joseph Phleban of Fredericksburg, Virginia is a guy who likes adventure. Soccer, competitive swimming, football, wakeboarding, snowboarding, rugby, he did it all in his 23 years.

ankle amputation

Joe Phleban’s “Please Cut Here” tattoo.

In 2008, the day after he graduated from college, Phleban injured his ankle for the umpteenth time while wakeboarding. He wasn’t too concerned about it, was quite used to it in fact, as he’d been plagued with painful ankle problems for 6 years –  a side effect of being a daredevil.

He expected the surgery to repair his ankle to be routine, but surgeons discovered that Phleban had developed a rare disease called Pigmented Villonodular Synovitis. PVS usually affects the knee, but in about 2 percent of cases it appears in the ankle, causing inflammation and tumors in the joint lining. Phleban’s PVS was far advanced, with tumors, dangerous inflammation, and extensive bone and tissue damage.

Pigmented Villonodular Synovitis produces malignant non-cancerous tumors which damage cartilage, causing painful, degenerative arthritis.

ankle amputation

Phleban uses mirror therapy to adjust to his amputation

Doctors performed a second operation to remove the tumors in Joe’s ankle, but they reappeared inside of six months. In 2010, Phleban underwent surgery yet again to remove more tumors, followed by radiation therapy. At that point, Joe’s doctors informed him that because his ankle had been so badly damaged, playing sports would be impossible. Phleban was crushed.

In March of this year, doctors ordered an MRI, which revealed that tumors had once again returned. His doctors recommended that they fuse the bones of the ankle, which would have meant periodic lifelong surgery and limited activity. Phleban didn’t care for that prospect, so he asked his doctors to amputate his lower leg. He figured he’d wear a prosthetic device and be able to do some sports afterward, and not be resigned to a life of surgeries, recoveries, walking boots, and canes.

ankle amputation

Phleban goes skydiving, checking one more thing off his bucket list.

In an interview with the U.K.’s Daily Mail Online, Pleban said, “Over six years I had to give up all of the sports I loved. Although taking my ankle away was a big sacrifice, the chance to regain the ability to play those sports again meant it was a no-brainer. It came down to either going through surgeries for a good portion of my life or have one surgery to end them all and be as active as I want on a prosthetic.”

And then he made a bucket list. A one-last-time run at unfulfilled adventures. All of it chronicled, from the point of view of his soon-to-not-be-there appendage, on a Facebook page called The Last Adventures of Joe’s Left Foot. Paintballing, go-karting, watersliding, a Caribbean vacation with his girlfriend, skydiving, and concerts. He even got a tattoo – a dotted line that wrapped around his intended amputation, with the words, Please Cut Here. Which he emailed to his surgeon.

In June, Phleban’s foot was amputated at Georgetown University Hospital in Washington, D.C. “Right before the surgery, I was definitely freaking out a bit,” he said. “It was such a ‘no turning back’ decision. But as soon as I woke up from the surgery and looked down, I knew I had done the right thing.”

exercising after ankle amputation

Phleban exercising with his girlfirend after his amputation

Phleban shared at least one plan for the future. This Halloween, he’s planning to dress up “as a surfer, my girlfriend as a shark.”

Bunion Surgery Without Bone Screws

22 May

A bunionectomy (the repair of a bunion deformity) is one of the most common outpatient procedures performed by podiatric surgeons like those at PA Foot and Ankle Associates.

There are a number of different kinds of surgeries to repair bunions, depending on the patient’s condition. In most cases, an incision is made on the top or side of the big toe, and parts of the bone and soft tissue are either removed or realigned. The bones are held in place with surgical bone screws, a process called fixation. The surgery restores normal function and movement to the big toe, joint, metatarsal, tendons, and soft tissue, relieving pain and discomfort.

Bone fixation is necessary so the patient can get back on their feet as soon as possible and spend less time in a surgical boot. Without fixation of any kind, a patient would have to stay off of their feet for weeks after bunion surgery until the bones in their feet were capable of bearing their full body weight.

In 90% of cases, bunion surgery with screw fixation is successful and the patient has no problems. But for some, the head of the screw or the threads can cause irritation and soreness, requiring a 2nd, minor procedure to remove the screws from the bones.

No Surgical Screws

Dr. Thomas Rocchio at PA Foot and Ankle Associates takes a no-screws approach to bunion surgery, yet his patients are back on their feet quickly. His secret is SonicPin, a system which uses a specially designed drill to prepare the bone site, and a liquid polymer to fixate the bones. It offers all of the strength of screw fixation, with none of the potential side effects.

SonicPin is loaded into a hand piece, which is inserted into the bone. Then, the SonicPin is melted via sonic vibrations. Within seconds, the liquid polymer flows into the area to be fixated, and cools almost immediately.  As the bones heal, the polymer is easily absorbed into the patient’s body with no side effects.

Watch the bunionectomy video below to see how Dr. Rocchio uses SonicPin.


Sochi Winter Olympics: Kelly Gunther’s amazing return after devastating ankle injury

29 Jan
While skating in Olympic trials in 2010, the unthinkable happened to Kelly Gunther. She was looking more and more like a potential Olympic medalist – she’d been skating since the age of six, had won several relay gold medals as a member of the Junior World Championship squad for inline skating, and had narrowly missed a spot on the 2010 U.S. Olympic team for Long Track Speedskating.

kelly gunther sochi olympics speed skating ankle injury

In March of 2010, during a 500-meter race at the American Cup series in Utah, Gunther suddenly, unexpectedly fell. She lost control when one foot tangled with the other, and she slid toward the barrier blades first.  One skate stuck in the wall, and the other came down on her boot, slicing the bone just below her left ankle. She had a double compound fracture and the skin on her ankle was lacerated, exposing bone, tendon, muscle, everything. And she was losing lots of blood. “My foot was hanging off my leg,” she said, and later remarked that if the paramedics hadn’t had the training and good sense to cut her skate from her foot, it would have probably come off in the boot. “I knew my ankle was broken, but I had no idea it wasn’t attached to my leg.”

Yet – and you may find this hard to believe –  Gunther skated two personal best times a year later, made the World Cup Team for 2011-2012, and placed third in the 1000 meters at the 2011-2012 National Championships. At the 2014 U.S. Olympic Trials, she skated her best-ever time in the 1000 meters to place fourth, winning her a spot on the U.S. Olympic Long Track Speedskating Team headed for Sochi. They don’t call her the comeback kid for nothing.  “I’ve definitely come through a lot”, she says, “and it just shows right there that you can never give up. You have to keep fighting for what you want.”

How did she come back?

While she was still on the ice, paramedics started an IV, and doctors worked furiously to save her foot. Later, surgeons inserted 10 screws and a metal plate into Gunther’s foot and ankle to keep the broken bones together. She spent four months in a cast, and two months in a walking boot. Twice each day she underwent intensive rehabilitation at the U.S. Olympic Training Center in Colorado Springs, performing exercises like picking up marbles with her toes and then thrusting her foot into a bucket of ice to wriggle the cramps out. All the while her doctors feared that the bone which had been shorn off by the blade might die, and Kelly would lose half of her foot.

But six months later, she was back on the ice. Most thought her chances of competing again on an Olympic level were a distant dream, yet Gunther’s on her way to Sochi.

The memory of her accident is with her every day, a not-so-gentle reminder of how easily dreams can be dashed. Before each event, Kelly has to have her leg worked on for 15-20 minutes – stretching and massage – so she can get her ankle into her clap skate. “It’s a reminder every day of how bad it was,” she says. “To keep fighting and how strong [the leg] is now, it’s almost stronger now than before I had fallen.”

What a remarkable story of determination. Kelly Gunther joins her fellow athletes on the Women’s Olympic Longtrack Speedskating Team: Brittany Bowe, Lauren Cholewinski, Maria Lamb, Heather Richardson, Anna Ringsred, Jilleanne Rookard, and Sugar Todd.

What Is A Tailor’s Bunion?

9 Oct
tailors bunion

Even though it appears small, a Tailors Bunion below the samll toe can cause significant pain

A bunion is an abnormal growth that appears on the joint at the base of your big toe. It’s caused when your big toe pushes up against your other toes, forcing the big toe joint in the opposite direction, away and to the inside of your foot. Over time, the stress enlarges your big toe joint, pushing the big toe even further against your smaller toes and causing significant pain.

A Tailor’s Bunion is similar to a bunion, but appears on the opposite side of your foot. It’s formed for the same reasons a bunion is – inherited foot structure aggravated by footwear – but it affects the joint at the base of your small toe where it joins your foot.

Specifically, a Tailor’s bunionalso called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. That is, the rounded end of the bone slowly moves away from the foot.

A Bunionette is not always painful. Just like a bunion, it usually develops slowly over a number of years, in one or both feet, and becomes acute in middle age. If it gets large enough, it can be quite troublesome, especially when shoes are too tight and rub against the bunionette, or if high heels are worn, shifting the body weight and pressure to the front of the foot. Typically, a callus also develops on the bottom outside of the small toe joint, which can also be quite painful and sore.

If you’re developing a Tailor’s Bunion

  • See a podiatrist so that he or she can create a baseline and monitor your condition. Surgery is usually not indicated in the early stages.
  • Wear appropriate shoes – pointy toe boxes and high heels should be removed from your shoe rotation, as these will make the bunion worse and create significant pain. Wear athletic shoes as often as possible and flats for business attire.
  • Use padding or a silicone bunion guard (available over the counter) inside your shoes. This will offer some protection against the shoe rubbing and causing the Tailor’s bunion to become irritated.
  • Ice the bunionette for 10 minutes three times per day.
  • Use ibuprofen (advil) to control the pain and soreness.

When is surgery indicated for a Tailor’s Bunion?

Only your podiatrist can tell you when bunion surgery is necessary. As every person’s condition is unique, there are a number of surgical procedures that may be most effective for your condition.


Dr. Adam Teichman of PA Foot and Ankle Associates performs a bunionectomy on a patient with a Tailor’s Bunion. Dr. Teichman narrates.

Angels’ Albert Pujols Out With Plantar Fascia Tear

29 Jul

pujolsLos Angeles Angels slugger Albert Pujols, who has been struggling with plantar fasciitis in his left foot for seven years (that’s right, 7 years!), is most likely out for the rest of the season after tearing his plantar fascia in Friday night’s game against Oakland. Angels’ Manager Mike Scioscia said that Pujols, who hit .258 with 17 home runs and 64 RBI’s despite being hobbled all season by the troublesome foot, will be out “for a significant amount of time.”

Back in April Pujols, 33, said of his plantar fasciitis, “I’m dying. It’s hurting real bad.”  He was considering off season surgery, and he sort of got his wish Friday night when he tore the ligament, achieving a similar result. In plantar fascia surgery, a podiatric surgeon cuts part of the plantar fascia ligament to release tension and relieve inflammation. The surrounding soft tissue attaches to the plantar fascia and helps it heal. Unfortunately for Pujols, he didn’t suffer a complete tear, so off-season surgery may still be an option.

The minimum recovery period for a plantar fascia tear is six weeks, but with the Angels all but out of playoff contention and a season-high 13 games behind Oakland in the American League West, there is no need to bring Pujols back for the final two weeks of the season. Instead of having surgery in October and spending most of the winter rehabbing, Pujols  can spend the rest of the summer recovering and come back healthy in 2014.

plantar-fasciitis diagramJust goes to show what we always say – don’t play through the pain, because it will always get worse, sometimes seriously.  It’s remarkable that even with the Angels’ state of the art sports medicine, highly paid trainers, and months to rest in every off season, Pujols’ plantar fasciitis never sufficiently healed. It’s a particularly difficult injury to treat in some cases.

Even if you’re an amateur athlete – especially you marathon runners – you may easily be exposing your feet to the same pounding an MLB player like Pujols does.  Any sign of pain – toes, heel, arch, or ankle – needs to be addressed immediately and given time to properly heal. Being out of the game temporarily, even for a full season, is much better than aggravating a minor condition into a serious injury which can sideline you for much longer.

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