Orthopedic foot and ankle surgery often involves the surgical treatment of the structures of the foot and ankle. Dr. Loncarich is a board-certified orthopedic surgeon who performs all of the procedures. His training and experiences provide him with the knowledge for appropriate surgical treatment of a given orthopedic foot and ankle problem. He performs most of his surgery at Texas Orthopedic Hospital but also has privileges to perform surgery at Houston Methodist Hospital. Most foot and ankle procedures are performed on an outpatient basis, but if hospital admission is required, he also has to admit privileges at both of these facilities. The operative team involves anesthesiologists, nurse anesthestist, perioperative nurses, as well as surgical assistants. Each team member has the goal of ensuring the completion of the procedure with the highest quality of care and respect.
TYPES OF FOOT SURGERY
Fusions: These procedures are most often performed to treat arthritic conditions of the foot and ankle. The surgical procedure involves removing all remaining cartilage from the joint and then joining the bones together with plates or screws so that they do not move. The goal is to stabilize the joint by having the two bones grow together. This removes the arthritis and the source of pain.
Hallux Valgus/Bunion Surgery: Hallux valgus//bunion deformity involves an angular deformity and bony prominence of the great toe. Often times these result in pain and difficulties with shoe wear and activity. These may require surgery to realign the great toe, decrease the bony prominence and improve pain. Surgery often involves breaking the metatarsal bone, releasing and tightening the ligaments around the great toe joint, as well as shaving off the bony prominence. Numerous techniques are available, but Dr. Loncarich will select the most appropriate procedure given the deformity that is present.
Hammertoes: Hammertoes are angular deformity of the second, third, fourth, and fifth toes of the foot. These generally develop over time though some can be related to trauma. Most patients will complain of pain and difficulty with shoe wear and activities. Different surgical technics are utilized to correct the hammertoe deformity some involve tendon transfers as well as tendon releases while other procedures involve resection of the stiff and deformed joints. Oftentimes these are held in position with pins, screws, or other types of the implants. The exact procedure performed would be dependent on the deformity present.
Neuroma Surgery: Neuromas are benign enlargement of the nerves around the foot and ankle. The most common is a Morton’s neuroma which results in pain in the ball of the foot. Neuromas can occur in any nerve though and can often times be seen as a result of a traumatic injury, a surgical complication, or from chronic compression/entrapment. Neuroma surgery involves either decompressing/freeing up the nerve, excising the nerve, or moving the nerve to an area where it does not irritate the patient.
Arthoscopic Surgery: Arthroscopic surgery involves placing small cameras and instruments into the ankle joint. Small incisions are made around the ankle to allow access and visualization of the structures inside the ankle joint. Multiple different abnormalities can be treated successfully with arthroscopic surgery. This includes lesions involving the cartilage as well as inflammatory and degenerative processes. Arthroscopic surgery generally provides for more rapid recovery with less pain and disability.
Reconstructive surgery: These are complex surgical procedures on the foot and ankle that are performed to stabilize different joints, realign and correct deformity, prevent further deformity, and reduced pain and disability. These procedures may require tendon repair or transfer, fusion of bones, breaking and realigning the bones along with utilization of internal and external devices to stabilize and repair the bones, ligaments and tendons during this procedure.
PREOPERATIVE TESTING AND CARE
Patients who are planning a foot and ankle procedure will require an evaluation prior to surgery to ensure that the procedure will be completed successfully. The patient will be evaluated at the preoperative anesthesia clinic where a complete medical history will be performed, the patient will meet with the anesthesiologists, and preoperative testing will be performed. Often times, an evaluation and further testing by the patient’s primary care physician, cardiologist or other specialist may be required prior to surgery being completed.
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