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Mar/21/2014 




Man who lost thumb gets big toe as replacement | Medical Alert - WBAL Home

A Baltimore County man is thankful to have the use of both of his hands after he lost his left thumb during a saw accident and doctors found a creative way to replace it.

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Corey Taylor shows off his new thumb that was created with his big toe.
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Corey Taylor shows off his new thumb that was created with his big toe.

Corey Taylor said he takes pride in doing everyday tasks like buttoning his shirt because he lost his left thumb using a saw in 2011. Doctors replaced it with his big toe.


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"I can do everything I was able to do before with no problem," Taylor told 11 News.


After the accident, Taylor went without a thumb for six months while he healed. He said it was extremely difficult to do menial tasks like grabbing onto things.


Dr. Ryan Katz at the Curtis National Hand Center at Union Memorial Hospital in Baltimore suggested using Taylor's big toe as a replacement. He said the center does about five such surgeries a year.


"You have to be very precise in dissecting out all of the elements of the toe, and all of the elements of the toe are all of the elements of the missing thumb. So you have bone, tendon, nerve, skin, soft tissue. Everything you need is down there," Katz said.


Doctors said most patients don't have any problem with balance once they lose a toe. The toe works well as a thumb because they function very similarly.


"When you're trying to reconstruct a thumb, you say, 'What's missing, and where can we get that to help rebuild the thumb?' When you're missing the thumb, you're missing length, sensibility, motion and aesthetic, and a toe has all of that," Katz said.


After the transplant, Taylor went through months of physical therapy to learn how to use his new thumb just like the old one.


"Recovery and the rehabilitation -- a lot of that was stretching, getting the thumb to move and work, and picking up little things," Taylor said.


"The thing that's the hardest to get back is the motion, and that's really the thing we're focusing on," Katz said.


It's been two years since Taylor's transplant, and he said life is back to normal. He said he doesn't even notice anything different about his left thumb.


"Every time I mention it to everybody, they're astounded. They don't even believe it's my big toe," Taylor said. "It's great. I couldn't ask for anything better. I've told Dr. Katz he's a miracle worker."



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Mar/19/2014 




Bunions: Bunion Pain

Bunions and Bunion Pain
Treatment and Bunion Surgery Options
A bunion is a painful deformity of the joint where the bones of the foot and the big toe meet. The enlargement of the bone and tissue around this joint is known as a bunion or hallux valgus. Symptoms of a bunion include a swollen bursal sac, a bony deformity on the side of the great toe joint, tender and swollen tissues surrounding the deformity, and displacement of the big toe, which may turn inward.

Intermittent or chronic pain can result from bunions and the high rate of use makes it difficult to rest and allow the agitation of the bunion to subside. The bone deformity or the enlargement of the big toe joint will be permanent, unless corrected with bunion surgery. The swelling of bursal sac and the soft tissues surrounding the bunion can be reduced greatly if rest and proper care is taken.

Additional bone formation is the main source of the bunion, often concurring with misalignment of the big toe. Bunions can also occur on the smallest toe, the 5th or pinky toe, which is far less common and known as a tailor's bunion.

There is a wide rage of treatment options for those who suffer from bunions. If the bunion is mild and does not require bunion surgery, resting the foot and avoiding excessive exercise or walking will help. Wearing shoes that have a wider toe opening, including sandals, can relieve the rubbing and irritation that comes along with more confining shoes. High-heeled shoes should be avoided as they push the big toe outward and can inflame the joint of a bunion.Anti-inflammatory medications (aspirin, ibuprofen, etc.) usually ease inflammation and target pain as well. If the bunion does become inflamed and irritated, application of an ice pack can reduce swelling and pain.

If the inflammation because excessive, cortisone can be injected at the site of the bunion to reduce the swelling at the joint of the big toe.

Bunion surgery is an option for those who have persisting pain and the condition is worsening. Surgery on a bunion can correct the bone deformity, increase function and relieve pain. Bunion surgery should not be considered lightly, the surgery is often successful but there is a rate of surgical failure. The big toe can move back into its previous place if the patient does not follow instructions, which will result in the pain returning. The surgical failure for bunions can be reduced greatly if activity restrictions are followed and proper footwear is worn after surgery.




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Mar/17/2014 

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Mar/16/2014 




Painful Tailor’s bunion, surgical correction of Tailor’s bunion. | Best Podiatrist NYC – Lawrence Silverberg, DPM 20 E. 46th St. New York, NY 10017 The best bunion surgery & hammertoe surgery in NYC

Today a young lady came in with a complaint of a large bump behind her fifth toe and added that her fifth toe is turning under her fourth. She has pain when she runs and works out. This has been getting progressively worse over the past six months.

I diagnosed her with a Tailor's Bunion (also called a Bunionette). See picture below: (click any picture to enlarge)

image

Tailor's bunion is a prominence of the fifth metatarsal bone at the base of the little toe. The deformity received its name because tailors sat cross-legged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.

Usually a tailor's bunion is caused by an inherited faulty mechanical structure of the foot. In these cases, changes occur in the foot's bony framework, resulting in the development of an enlargement. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward. This shift creates a bump on the outside of the foot that becomes irritated whenever a shoe presses against it. Sometimes a tailor's bunion is actually a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head.

In the case of this patient, the fifth metatarsal bone was angulated toward the outside.

Treatment for tailor's bunion: I informed her all about the surgical correction of Tailor's Bunion where I make a small incision On the side of the foot and access the bone. I then cut a small wedge in the bone to change the angle toward the inside of the foot. After the bone wedge is removed, I placed a tiny titanium screw in order to hold it in place to heal.

Recovery from tailor's bunion surgery: For people with a desk job I can do the surgery on a Friday and send them back to work on Monday in a surgical shoe or boot. This patient, however, has a job in which she is on her feet doing sales. I advised her that she would need to take 2-3 weeks off of work or work at a desk if possible. She chose to wait until the Fall to perform her surgery when her work schedule is lighter and she can work in the office, rather than on her feet doing sales calls.
(C) Copyright 2010Best Podiatrist NYCLawrence Silverberg, DPMCity Footcare, PC130 E 35th StreetNew York, NY 10016212-871-0800www.cityfootcare.comcityfootcare@gmail.comSpecializing in foot surgery, bunion surgery, hammertoe surgery, cosmetic foot surgery, general podiatric surgery.


Related posts:
Another soft tissue mass to remove this week. - podiatrist NYCRecurrent Ganglion of tendon sheath - Podiatrist NYCCase of the day - fibular stress fracture - Podiatrist NYCWelcome to Lawrence Silverberg's Podiatry Blog
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Mar/14/2014 

Bunions, Causes, Tests, Diagnosis & Treatment

Bunions are a painful condition that affects many women in America. This common deformity of the toes is believed to be largely a result of wearing very narrow shoes that are too tight, as well as shoes with high heels. Although there are other possible causes for bunions, it is probably no coincidence that 9 out of 10 individuals suffering from bunions are women, according to the American Academy of Orthopaedic Surgeons (AAOS).


Definition

When a bunion forms, the joint connecting the big toe to the foot becomes swollen and develops a painful bump. When the big toe is compressed against the other toes, it forces the big toe joint into the opposite direction. When this happens, the joint in the big toe eventually becomes enlarged. The toes continue to be crowded and pain occurs. Eventually, a painful bunion develops overtime.


Similar to a bunion is a bunionette, also known as a tailor's bunion. These smaller bunions form on the joint at the base of the little toes. It develops in the same way a bunion does, but occurs in a different spot.


Symptoms

There are many painful conditions that can develop on the foot. In addition to bunions, individuals can develop hard corns and bursitis. Symptoms of bunions will develop along the inside edge of the large toe. Bunion symptoms include:

A bony, bulging bump
Swelling in the joint
Redness in the joint
Soreness in the joint
Pain in the joint that worsens when wearing shoes
Big toe facing inward toward the other toes
Calluses at the overlap of the first and second toes
Limited movement of toe (restricted range of motion)

Pain is one of the most common bunion symptoms, and may occur before a bony bump develops. Bunion pain can be severe enough to prevent you from being able to wear shoes. As the bunion progresses, the pain increases and the bump begins to develop.


Causes

Because bunions are much more common in women, they are believed by many to be a result of wearing high heeled shoes, or shoes that are too narrow or too tight. Not surprisingly, the majority of bunion sufferers are women. Although there may be other causes for the development of bunions, ill-fitting shoes that put stress on the foot are largely to blame. Other possible causes for bunions include:

Heredity
Abnormal bones structure of the foot from birth
Inherited structural defects of the foot
Arthritis or other medical conditions

Risk Factors

There are certain risk factors associated with the development of bunions. Because high-heeled shoes that crowd the toes are the number one cause of bunions, avoiding them is recommended. Other risk factors for bunions include:

Wearing poor-fitting shoes that are too tight, too narrow or too pointy
Having a personal or family history of arthritis
Hereditary factors such as inherited foot defects

Diagnostic Tests

Most doctors will be able to accurately diagnose bunions by simply looking at the foot. Your doctor will carefully examine your foot and ask you to wiggle your big toe. He will monitor your range of motion and determine if it is limited. He will check to see if there is any redness or inflammation in the toe. Occasionally, your doctor may order a foot x-ray to check if an abnormal angle exists between the foot and the large toe. An x-ray may also be able to detect if arthritis is present in the foot.


Treatment

It is important to take appropriate measures as soon as a bunion forms. With proper self-care and avoidance or risk factors, you may be able to prevent the condition from worsening without further medical intervention. Simple home-care tips for bunions include:

Wearing shoes that have a wide-toe
Placing foam pads around the bunion to protect it from further irritation
Wearing spacers on the toes to separate them
Cutting a toe hole in your house shoes to ease discomfort when you are at home
Replacing all poor-fitting shoes with those that provide enough room for the toes to fit comfortably
Using over-the-counter foam arch supports
Apply an ice pack to reduce swelling

If the bunion pain does not respond to simple home remedies or continue to grow, additional measures may be necessary. Medical treatments will vary according to the severity of the bunion and the amount of pain you are experiencing. More advanced treatment options for bunions include:

Non-steroidal anti-inflammatory medications (NSAID's)
Prescription strength pain relievers
Cortisone injections
Prescription orthotic devices

In extreme cases, when bunions do not respond to any of the above home remedies and treatments, surgery may be required. There are a variety of surgical procedures that can be effective at removing bunions. The type of surgery used will depend largely on the size of the bunion, the amount of pain it is causing and the underlying cause for the development of the bunion.


During surgery, the toe is realigned and the bony bump is removed. The swollen tissue that develops around the big toe joint is also removed. Parts of the bone in the big toe are removed to help straighten out the toe. The long bone that stretches from the back of the foot to the big toe is realigned to straighten out the angle in the large toe joint.


Although bunion surgery has a relatively high success rate, it generally is not recommended unless the condition is severe or interfering with normal every day activities. There are risks involved with the procedure, similar to those that are present for any surgical procedure.


Complications

Bunions are a permanent condition that will not go away without surgery. Smaller bunions that are not painful can often be managed with simple remedies. Larger or more painful bunions may require advanced treatment.


If bursitis occurs, a condition in which the sac of fluid over the joint becomes inflamed, the bunion can become much more severe and can cause intense pain. If bunions continue to grow and become more painful, simple remedies may become less effective and surgery may be required.


Prevention

The best prevention for bunions is to avoid wearing high heeled or poor-fitting shoes. Avoid wearing shoes that squish the toes together or cause too much friction among the toes.


When To Call Your Doctor

Contact your doctor is you have a bunion that does not respond to simple home care treatments. If the bunion continues to cause pain and interferes with your normal daily activities, schedule an appointment with your physician. Contact your doctor immediately if you develop any signs of infection such as swelling, redness or heat. If you are unsure of the cause of your foot condition, make an appointment to have your foot evaluated by your doctor.


Sources:
AAOS
Mayo Clinic
PubMed Health
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Mar/11/2014 


There are a number of methods which can be used to reduce the pain from plantar fasciitis. Treating plantar fasciitis usually involves medication to ease the pain. This is most commonly anti-inflammatory drugs (NSAID's) which are helpful in alleviating pain as well as reducing inflammation. Sometimes corticosteroids may be administered either topically or by injection into the plantar fascia directly, although this is usually reserved for only the most severe cases. Extracorporeal shock wave therapy (ESWT) can be used to good effect, with the treatment using painless sound waves to help the healing process.

Plantar fasciitis occurs often in runners and other athletes. Plantar fasciitis is the most frequent cause of plantar (bottom of the foot) heel pain. For many years pain in this region has been incorrectly termed the "heel spur syndrome". It is better termed the "plantar heel pain syndrome" since a heel spur is not always found at this location. While a "heel spur" sounds ominous often the spur is present and does not cause any pain. The formation of a spur is a sign that too much tension has developed within the plantar fascia, partially tearing from its origin at the calcaneus (heel bone).

Normally the Plantar Fascia is very tough and flexible to withstand forces transmitted during walking or running. The normal function can be however affected by excessive abuse of the feet, over-pronation, old age or being over-weight. As a result of the painful stretching the Plantar Fascia exhibits micro-tearing that leads to irritation, inflammation and pain at the junction of the Plantar Fascia and calcaneus or heel bone. The continued pulling of the Fascia joined to the heel bone can result in a bony growth on the heel commonly known as a Heel Spur. This growth triggers pain in the surrounding tissues that get inflamed.

While structural foot abnormalities such as high arches or fallen arches can make one more susceptible to plantar fasciitis, wearing old worn-out shoes can also cause stress to the plantar fascia. Wearing high-heeled shoes can also stretch the ligament beyond the tolerable limits and cause inflammation. Those suffering from plantar fasciitis are also at an increased risk of developing heel spurs. Heel spurs, also known as osteophytes, are abnormal bony outgrowths that may develop along the edges of the heel bone. Heel spurs form when the plantar fascia starts pulling at the heel bone or gets torn due to excessive stress.

For runners, the plantar fascia may become inflamed after a period of running hilly courses or running in excessively worn shoes or the wrong type of shoe for your foot type. Once this happens, a cycle of inflammation ensues. There is a nerve (called the medial calcaneal nerve) that runs along on the inside of the heel bone and actually curves down around the bottom of the heel between the bone and the plantar fascia. As you walk and place stress on the plantar fascia, the tugging of this ligament where it attaches to the heel bone stimulates inflammation. This causes the sharp pain. plantar fasciitis exercises

Some people with normal arches or high arches get heel pain and plantar fasciitis as well. This is usually caused by muscle imbalances in the foot or lower leg. Some people have normal arches while standing but when they stand their arches fall. Either way, the first solution is to get custom orthotic inserts made for your shoes. This doesn't mean the cheap ones you get at a pharmacy. You need to find someone who makes custom orthotic inserts that can be made specific for your feet. These can cost from $75 to $300. This is expensive but can be very effective.

When the plantar fascia, or the thick tissue in the bottom of the foot that connects the heel to the toes, becomes overstretched, it becomes inflamed. This condition is known as plantar fasciitis. This inflammation makes it difficult to walk and perform certain movements of the foot. It may be caused by shoes with poor support; sudden weight gain; long distance running, especially downhill or on uneven surfaces; or a tight Achilles tendon. People whose feet have a high arch or are flat footed are also prone to plantar fasciitis. You Might Also Like Symptoms.

In general, plantar fasciitis is a self-limiting condition. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. 3 Athletes, active adults and persons whose occupations require lots of walking may not be compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of “relative rest” that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance with the treatment plan. 4

Patients try various remedies for the treatment of plantar fasciitis. Surgery is only the last option. PF insoles are proven to work for several people. Insole treatment is now considered a long-lasting solution to PF and various other foot related problems. Insoles very gently reposition your feet by acting on the arches. A good arch support is fitted inside your shoe according to a prescribed plan of use recommended by your podiatrist. Over a period of time, the arch supports become gentler which helps in the healing process. With the progression of the therapy, the focus is on maintaining the right alignment instead of changing it.

Plantar fasciitis is usually treated with medications. The most popular one is painkiller that includes ibuprofen and naproxen. Another one is the corticosteroid which can either be applied topically or injected on the affected area. Therapy is also a popular cure because it is non-invasive and generally risk free. Physical therapy is helpful because it helps in relieving the pain and at the same time helps in strengthening the muscles of the feet. It can cure twisted plantar fascia nerve and can bring back its natural condition. Night splints are also helpful because they help in aggravating the situation. plantar fasciitis shoes
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