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Posts for: January, 2021

By Dr David Cheskis
January 30, 2021
Category: Foot Care

                                  Avascular Necrosis of the Sesamoids

Your sesamoids are two small bones under the base of your big toe that help provide leverage for normal toe biomechanics. Every time the ball of your foot strikes the ground, weight is transferred through your sesamoids. Functioning like your kneecap, your sesamoids enable your toe joint to bend with more strength and stability. Overuse of your big toe typically causes a sesamoid disorder. Runners, cyclists, and people who abruptly increase their training regimen are at an increased risk of suffering a sesamoid disorder if they overuse the muscles and tendons that bend their big toes. 

Loss of blood supply in your sesamoids is rare, but it can be caused whenever damage in the tissue surrounding the sesamoids decreases their blood supply. If the blood supply to these small bones is compromised, a diagnosis known as Avascular necrosis (AVN) can ensue. AVN of the sesamoid is pathology of the medial or lateral hallucal sesamoid resulting in pain under the first metatarsophalangeal joint often presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. Often advanced imaging such as CT scan, bone scan or MRI is necessary to make the exact diagnosis. Nonoperative modalities are designed to offload the sesamoid. Boot immobilization and a non-weightbearing protocol can be effective in the acute sages of deformity. Use of a bone stimulator daily can help physiological healing of the bones. Transition into a special orthotic with a cutout modification for these bones can be very effective to reduce symptoms and allow for pain-free gait. AVN that is advanced can lead to fragmentation and atrophy of the sesamoids. The only operative treatment used for AVN of the sesamoid is excision of the involved bone, which results most commonly in complete patient satisfaction. Please schedule a timely evaluation if you feel sharp pain under the great toe to determine if your sesamoids are the cause!


By Dr David Ehrlich
January 30, 2021
Category: Foot Care

Nearly 100 bunionectomy procedures have been described in surgery literature. This variety exists because surgeons take into account the severity of the deformity, the quality of the involved joints, the quality of the bone, the age of the patient, and many other factors. While some of these procedures have fallen out of favor due to new technology and discoveries in surgical techniques, one procedure known as the Lapidus bunionectomy has withstood the test of time.

Bunion correction is more nuanced than simply removing the “bump” from the great toe. A bunion is a deformity that can occur in all three planes of the human body and often involves the 1st metatarsal bone splaying away from the 2nd metatarsal bone. Therefore, correction often involves creating a bone cut in the first metatarsal bone, shifting it back into place, and inserting a screw to maintain the newly corrected position. When the deformity is more severe and the 1st metatarsal is splayed far from the 2nd metatarsal, the correction is achieved more towards the middle of the foot to get a better lever arm for correction. In these severe cases, or in individuals who have laxity of the midfoot, the Lapidus bunionectomy is the procedure of choice.

                                Lapidus Bunionectomy

The Lapidus bunionectomy involves fusing the 1st metatarsal bone to its neighboring bone of the midfoot known as the cuneiform. By fusing this joint farther back on the foot, a higher level of correction can be achieved for these severe cases. Because this fusion occurs at the origin of the deformity, patients who undergo this procedure have the lowest recurrence rates of their bunion deformities. Traditionally, the correction and fusion were maintained by wires or screws. Because these implants are less stable, patients would have to be placed in a cast for up to 8 weeks then slowly transitioned back to sneakers. However, with the advent of newerimplants and techniques, patients no longer require casts and may be walking on their foot within weeks of the surgery!

The doctors of Advanced Podiatry have much experience in performing the Lapidus bunionectomy. We carefully select patients who are the right candidates for this more technical type of bunionectomy, and our results speak for themselves!

                                              Lapidus Bunionectomy

                                 Lapidus Bunionectomy


By Dr Arden Smith
January 25, 2021
Category: Foot Care
Toddler shoes can be tricky. You want footwear that looks good, for sure, but when it comes to toddler shoes for boys and girls, it’s what’s on the inside that counts. The primary goal is to protect their little feet. They are learning how to walk and when you put on the shoe, it prevents them from slipping.
 
The key elements to look for make total sense. You want a flexible shoe without a rigid sole. You want the foot to develop on its own. In a perfect world, toddlers could walk barefoot, but in this case a thin sole protects their feet. When it comes to sizing, make sure you ask if there’s any pain, or if the shoe rubs anything. You want a little bit of room, a thumbs width, in the toebox, so there’s room to grow. It’s important to have them try on the shoe and be able to test them and wear them around.
 
If you have any questions regarding shoes for your toddler, or would like your toddler's shoes checked, please call Advanced Podiatry of Manhasset, Huntington, Plainview, or Maspeth and one of our expert podiatrists will be happy to evaluate your child and answer your questions.

By Dr Aarti Kumar
January 22, 2021
Category: Foot Care
Temperatures are dropping but that is no excuse to sit indoors and not have any fun. Whether you want to go for a stroll around the neighborhood or dive into ski or snow boarding season, be sure to keep your feet warm. Not wearing the appropriate shoe gear or layers can lead to a condition called frostbite. Frostbite is a condition in which freezing temperatures can damage the skin due to damage surrounding blood vessels and possible cell death. Because of their location away from the core, the feet, hands, nose and ears become areas of special concern during cold injury. 
 
Lower temperatures tend to narrow or constrict blood vessels which decreases supply to our skin and tissues. Underlying medical conditions such as diabetes and peripheral vascular disease can make one more prone to frostbite injury.
 
Pain and irritation are common symptoms of cold exposure. If a deeper frostbite injury has occured, numbness, burning and blistering can also occur.  It is very important to avoid extreme heat when treating frostbite- however tempting it may be, remember to avoid heaters or blow dryers as they can result in further injury. 
 
Remember to wear warm layers when going out in the cold and wear proper fitting boots/shoes during activity. Shoe gear should never be snug or tight-allow some room for your toes to wiggle. Too big of a shoe is also no good as it can lead to blisters and chafing. 
 
If you suspect you have frostbite, immediately seek medical attention.

By Dr Arden Smith
January 17, 2021
Category: Diabetes
A small cut, or bruise may not seem like a big deal, but for millions of Americans with diabetes, they can be. For individuals with diabetes, all wounds are a serious health concern and require careful attention. 
 
People with diabetes are twice as likely to develop peripheral vascular disease, a condition of poor circulation. Diabetes can also weaken our immunity, which complicates wound healing. If your immune system isn’t functioning at its best, your body may struggle to fight off bacteria that cause infection. Higher than normal blood sugar levels increase the possibility of infection because bacteria thrive on the extra sugar that’s available in the bloodstream.
 
If your infection is untreated and left to spread, it can lead to complications such as gangrene, or sepsis, often resulting in hospitalization and amputation.
 
If you have any question regarding a diabetic foot wound please contact Advanced Podiatry of Manhasset, Huntington, Plainview, or Maspeth to be evaluated by one of our expert podiatrists as soon as possible. All of our expert doctors have had advanced training in the management of Diabetic Foot Infections.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



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Advanced Podiatry of Manhasset at the Americana

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Advanced Podiatry
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Manhasset, NY 11030
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Maspeth, NY 11378
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Plainview, NY 11803
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100 Middle Country Rd.
Coram, NY 11727
(631) 696-9636