Chronic Heel Pain / Plantar Fasciitis

When conservative treatment fails...

Surgery for Plantar Fasciitis: How It’s Performed and Who Needs It

Plantar fasciitis is the most common source of heel pain, affecting about 10 percent of the U.S. population. It occurs when the plantar fascia, a thick band of tissue running the length of the bottom of the foot, becomes inflamed and causes symptoms such as “first step” pain in the morning or pain after standing from periods of rest. For over 90 percent of patients, conservative treatment methods are effective in relieving their inflammation and associated symptoms. Others, however, may require surgical treatment.

What is the surgical release for Plantar Fasciitis? The most common surgery performed for plantar fasciitis is an Endoscopic Plantar Fasciotomy (EPF). This is an outpatient surgery that takes 15 to 20 minutes to perform and can be done with general anesthesia or sedation (twilight sleep). The surgery involves a small incision (roughly one centimeter) on either side of the heel. A surgical scope, or small camera, is placed in one incision and a small surgical hook is placed in the other incision. While fully visualizing the plantar fascia with the camera, the hook is used to cut a portion of the fascia. The hook and the camera are removed, and the incisions are closed with one or two stitches. There are no implanted materials during this procedure. The purpose of an EPF is to release a tight or contracted plantar fascia. The cut portion lengthens roughly one inch and heals in this lengthened position during the recovery.

What is the recovery for surgical release of the Plantar Fasciia (EPF)? The first portion of the recovery requires two weeks of non-weightbearing on the operative foot. Non-weightbearing can be aided by crutches, a walker, rolling knee scooter or a wheelchair. After the initial two weeks of non-weightbearing, patients progressively add pressure to the foot while wearing a walking boot for four weeks. This stage of the recovery takes four weeks. It is important not to “overdo it” during this time: too abrupt an increase in activity can delay the overall recovery. Most patients are ready to transition from the walking boot to a supportive shoe, like a tennis shoe at six weeks post-operative. It is typically 10 weeks from the time of the surgery when patients begin recreational physical activity.

How successful is Plantar Fasciitis surgery? The Endoscopic Plantar Fasciotomy (EPF) has roughly a 90% success rate. Other surgical procedures also have good success rates with their own advantages and disadvantages. Individual surgeons will have their own preference.

How often is surgery necessary for Plantar Fasciitis? Plantar fasciitis is extremely common, and the overwhelming majority is treatable without surgery. Between 3-5% of patients suffering from plantar fasciitis will not obtain relief with non-surgical treatment. For this small portion of patients who do not obtain relief, there are several surgical treatment options; the most commonly performed surgery for plantar fasciitis is an Endoscopic Plantar Fasciotomy (EPF).

If you are suffering from a case of plantar fasciitis that has not responded to more conservative treatment methods, surgery may be the right option for you. Contact Pasadena Orthopedics at (626) 517-0022 to request an appointment and further discuss your treatment options.

Ingrown Toenail (Permanent/Non Permanent)

Did you know there is a permanent solution to ingrown toenails so that you never have to deal with them again? Call 626-517-0022 to discuss further.

What is an ingrown toenail?

An ingrown toenail is a toenail that has grown into the skin instead of over it. This usually happens to the big toe, but it can also happen to other toes. An ingrown toenail can get infected. It may be painful, red, and swollen, and it may sometimes drain pus. (See a picture of an ingrown toenail)

Anyone can get an ingrown toenail, but adults get them more than children do. People who have curved or thick nails are more likely to get an ingrown toenail. This is more common in older adults.

What causes an ingrown toenail?

An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow into the skin. Wearing shoes or socks that don't fit well can also cause an ingrown toenail. If your shoes are too tight, such as a dress type shoe that is narrow at the front, might press the nail into the toe and cause it to grow into the skin.

You can get an ingrown toenail if you hurt your toe, such as stubbing it. This can cause the nail to grow inward. Repeating an activity that injuries the nail, such as kicking a soccer ball, can also cause an ingrown nail.

What are the symptoms?

The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.

How is an ingrown toenail diagnosed?

Dr. Shirazi will do a physical exam to diagnose an ingrown toenail. She will examine your toe where the nail has grown into the skin.

How is it treated?

Make an appointment ASAP as treatment is often more simple before the irritation or infection worsens. You may reach our office at 626-517-0022. In some cases, you may need antibiotics. Call Dr. Shirazi if your toe is red, warm, swollen, or drains pus, or if there are red streaks leading from your toe.

Do not use a sharp object like manicure scissors to dig under your nail, because this will worsen infection.

Wear comfortable shoes with a wide toe box, or sandals, that do not press on your toe.

If your toenail is very ingrown, your doctor might suggest a minor in office procedure to remove all or part of the ingrown nail.

During this procedure, Dr. Shirazi will numb your toe. Then she will cut the edge of the ingrown toenail and pull out the piece of nail. To prevent the nail from ever growing into the skin again, ask Dr. Shirazi about the permanent procedure option. She may take an extra pain-free step to destroy all or part of the nail root, if you are a good candidate. This is called a matrixectomy. If Dr. Shirazi removes all or part of your nail but does not destroy the root, it will begin to grow back within a few months.

After the minor procedure, it is important to take care of your toe so that it can heal. Our office will give you specific instructions to follow.

How can ingrown toenails be prevented?

You may be able to prevent ingrown toenails by wearing roomy and comfortable shoes and socks that do not press on your toes. If you work in a place where your toe might get hurt, wear sturdy shoes such as steel-toed boots to protect your toes.

Be sure to trim your toenails properly. You can do this by cutting your toenail straight across, not curved. Make sure you do not cut your toenail too short. You can also leave your toenail a little longer at the corners to help it grow over the skin.

If you have had a permanent nail avulsion, there is a 2-3% chance the nail may return. This is typically resolved with one more treatment.

If you have diabetes or peripheral arterial disease (poor circulation) talk with Dr. Shirazi before you trim your own toenails. People with diabetes have a hard time feeling their toes and might cut themselves without realizing it. Peripheral arterial disease can cause toes to be very painful.

The benefits of a Ingrown Toenail Treatment (Partial or Total Nail Avulsion) include:

• The procedure is done simply in-clinic

• The total appointment time typically doesn’t exceed 10-20 minutes

• The procedure is performed under local anesthetic (lidocaine) so it is pain-free

• You do not need to take any additional time off work/school following the procedure and can go home immediately

• You do not need any special boots or braces while the toe heals

• The procedure causes little post-procedure discomfort, however Tylenol can be taken should discomfort arise

• We dress your toe, provide you with a take-home dressing pack and re-dressing instructions. If you need a sandal, we will provide one for you.

• We monitor your progress to ensure it is healing well.

Also, be sure to ask our office about how we can help you and your loved ones trim your toenails on a bi-monthly basis. This is often covered by insurance.

Call Pasadena Orthopedics Inc. at 626-517-0022.

Fat Pad Augmentation (Leneva Injection)

...The good fat!

Fat Pad Augmentation in Pasadena, CA

Dr. Sara Shirazi is now offering an innovative procedure for patients with fat pad atrophy, painful corns, or pain at the ball of the foot. Leneva® is a procedure where an allograft adipose matrix derived from donated human tissue is used for tissue reconstruction. This is a safe and clinically proven solution to help with foot pain without steroid injections or surgery.

What is Leneva®

Leneva® is a first-of-its-kind human adipose tissue for tissue reconstruction. As an all-natural extracellular matrix, Leneva is a safe, natural, off-the-shelf solution that has multiple clinical applications including, but not limited to:

• Diabetic Foot Ulcers

• Pressure Ulcers

• Tunneling Wounds

• Fat Pad Reconstruction Procedures

Features & Benefits

• Ready to use out of packaging reducing procedural preparation time

• Wound treatment may allow for decreased long-term health costs from repeat patient visits due to wound recurrence

• Preservation of natural derived endogenous components (matrix proteins, growth factors, cytokines) vital to adipogenesis and angiogenesis

• Provides extracellular matrix that functions as a scaffold for patients own cells to create new fat

• Pre-clinical studies in athymic mice demonstrate significant adipocyte formation in the host

• Leneva is tested for sterility per USP<71> without the need for terminal sterilization methods

HOW IS LENEVA® DIFFERENT FROM OTHER TREATMENTS FOR FAT PAD ATROPHY?

One of the most frequent complaints we hear from new patients is painful pressure points located on the weight-bearing surface at ball of their forefoot. These pressure lesions can be caused by one or more of the following conditions: an abnormally positioned bone, toe deformities, or thinning of the fat pad cushioning the sole of the foot.

What’s so revolutionary about Leneva® is that the product organizes itself to fill in the fat deficient area, decreasing the likelihood of product displacement so that the material remains in the area where your doctor placed it. This not only provides the area with an instant fat cushion, taking the pressure off the area right away but also inserts a scaffolding that provides a space for your body to re-populate the scaffolding with new fat cells over time.

Schedule a Consultation

Call 626-517-0022 today to schedule a consultation for your Leneva® Foot Pad Augmentation treatment in Pasadena/Los Angeles. Our team can provide you with an effective solutions for any foot or ankle pain you are currently dealing with.

See our before & after side by side of a dear patient kind enough to share his results: