Foot & Ankle

Ankle Fusion
Trauma involving the ankle joint results in damage and pain to the ankle. Once injections, bracing, physical therapy and/or arthrodiastasis have failed, or if an individual is not a candidate for a Total Ankle Replacement, a fusion of the joint is performed to alleviate pain.

Ankle Joint Arthrodiastasis
The arthrodiastasis procedure is indicated as an alternative to fusion or joint replacement in the younger population. The distraction creates a larger space or distance between the distal tibia and the talus. A circular ring fixator is applied to the distal portion of the leg and foot for 6-10 weeks, followed by a period of physical therapy. During the distraction period, the patient is allowed to fully walk as tolerated. Arthrodiastasis can be performed with good results for patients who have a stiff ankle with or without previous joint replacement.

Innovative Treatment Saves leg – CBS news Video Clip >

Ankle Joint Replacement – InBone Total Ankle Now Available.
Until recently, there were limited options for ankle replacement in the U.S. The INBONE™ Total Ankle was developed as a viable surgical solution to ankle arthritis. This will allow patients to have pain reduction and restored mobility without the need or problems associated with an Ankle Fusion (Arthrodesis). The INBONE™ team that developed this implant carefully studied previous ankle designs to determine the causes of implant failure. With that knowledge, they used design elements that already have proven successful in hip and knee implants, INBONE™ engineers designed a total ankle replacement that could stand the test of time.

Long anchoring stems – The prosthesis has anchoring stems to secure it in place, within both the tibia and talus. This reduces the chances of the implant loosening over time, which has been a problem with other ankle implants.

Physician customized for patient needs – When it comes to joint implants anywhere in the body, one size does not fit all. The modular design of the tibial stem (component that goes into the leg) allows us to select the appropriate number of pieces based on patient size and bone structure. The result is a more precise fit and a less invasive installation process, with minimal bone removal. All of the components are available in multiple lengths and diameters for additional customization.

Anatomical matching to the human ankle. – Mother Nature knows best. That’s why the INBONE™ Total Ankle closely matches the shape of your natural ankle. This promotes natural movement and mobility.

Precision surgical fixtures designed to provide accurate installation. – A specially designed Foot Holder secures your foot while allowing the surgeon to precisely position the prosthesis. This eliminates any guess work on the surgeon’s part. No other ankle implant utilizes this type of installation guidance.

How does the Inbone™ Total Ankle work? – The prosthesis consists of two main pieces: a tibial component (that goes up into the leg) and a talar component (the replaced part of the ankle that articulates with the foot). The tibial component features a high strength polyethylene piece secured within a titanium holder. A long titanium stem securely anchors this half of the implant within the tibia (leg bone). The talar component is an anatomically shaped, highly polished cobalt chrome piece which also features a stem. The talar stem is inserted into the talus (ankle bone) to securely anchor this half of the implant. Once installed, the smooth plastic surface of the tibial component rotates effortlessly on the highly polished metal surface of the talar component, resulting in smooth, fluid movement.

Arthroscopic surgery
Technological instrumentation has led to the development of surgical techniques for the diagnosis and treatment of joint disorders. Arthroscopy is a procedure that utilizes 2-3 mini incisions around a particular joint and needle-like probes enter the joint. Dr. Pereira then introduces a tiny camera to inspect the joint. Additional instrumentation in then inserted through the other mini incision to perform the appropriate treatment within the joint. Unlike traditional joint surgery that requires large incisions to expose the joint, arthroscopy uses small openings to examine the joint. By eliminating the need for large incisions, arthroscopy reduces the risk of infection and swelling. Arthroscopy is performed as an outpatient procedure.

Bunion Correction
Enlargement of the bone just behind the great toe is called a bunion. If such a deformity can’t be accommodated with wider shoes, then reconstruction of the joint is considered. There are numerous ways to correct a bunion. Every bunion correction is custom tailored to the individual patient depending on patient needs. Post operative treatment for bunion correction can range from immediate walking to 6-8 weeks of not being able to bear weight on the surgical foot.

Cavus / high arch reconstruction:
Characterized by a high arch, contracted digits and instability of the foot, associated lower leg muscle weakness and may or may not have a neurologic component.

Procedures involving cavus foot reconstruction may vary from realignment surgery in the heel and/or mid-foot with or without tendon transfers. The goal of the reconstructive procedure is to lower the height of the arch and provide a more stable extremity for ambulation

Deformity Correction – Lower Limb:
Deformities may either be congenital or acquired after a traumatic event. Foot, ankle and leg deformity correction is performed at the center utilizing the latest and most innovative of surgical procedures. The deformed bony or soft tissue structures are brought into alignment via tendon lengthening, tendon transfers, realignment osteotomies, and/or fusions. Deformities are corrected either acutely or gradually. The goal of deformity correction is to allow for a stable extremity in order to walk effectively. Patients in need of limb lengthening, release of contractures after a stroke, traumatic brain injury, and cerebral palsy are candidates for deformity correction.

Diabetic Charcot Reconstruction:
The Limb Care Centre serves as a referral center for patients with diabetic Charcot foot deformities. This condition, properly called Charcot neuroarthropathy, develops in approximately 10% of individuals with diabetes. Of those people 10% develop the disease process to both feet. The condition results in a foot that undergoes spontaneous fractures, severe deformities and ultimately, ulcerations that may progress to an infection. If managed appropriately and in a timely fashion most patients are candidates for a Charcot reconstruction to allow them to ambulate on a stable foot.

Drop Foot surgery:
Drop foot is a result of muscle imbalance due to a nerve injury. Options for drop foot surgery are inclusive to nerve releases, nerve repair, tendon lengthening, tendon transfers and fusion of joints of the foot and ankle. The appropriate treatment is based on advanced diagnostic testing.

Flatfoot (Collapsed arch) Reconstruction:
A wide array of procedures can be performed for a flatfoot reconstruction. After determining the type of flat foot an individual has a surgical plan is put together and discussed with the patient. Flat foot procedures may range from simple tendon rebalancing procedures, to implants being inserted into the foot, to complex fusions of multiple foot and ankle joints along with realignment of appropriate joints. Dr. Pereira will discuss all options of a flatfoot reconstruction prior surgery.

Fracture management:
Surgical management of fractures of the leg, ankle and foot can be performed by two methods:
Internal Fixation: consist of realigning the fracture site and inserting screws and plates for adequate compression. This method requires non-weight bearing status for 4-8 weeks followed by physical therapy.
External Fixation: consist of realigning the fracture site by means of inserting wires through the skin and bone and attaching them to a circular frame. The External fixator additionally serves as a cast, with the advantage of also applying internal compression. This technique allows the patients to walk as tolerated immediately after surgery. Furthermore it also allows for early range of motion to decrease joint stiffness and muscle weakness

Hallux Distraction Arthrodiastasis:
The arthrodiastasis procedure is indicated for an alternative to fusion or joint replacement in the younger population. The distraction creates a larger space or distance between the big toe joint. A monolateral fixator is applied across the joint for 6-8 weeks, followed by a period of physical therapy. During the distraction period, the patient is allowed to fully walk as tolerated. Furthermore Arthrodiastasis can be performed with good results for patients who have a stiff big toe joint with or without previous joint replacement, and failed bunion surgery that prematurely leads to osteoarthritis of the big toe joint.

Hammer toe surgery:
Hammertoe, mallet toe are cross-over toe are terms used to describe an assortment of deformities of the toes. A frequently overlooked condition is called second toe instability, which produces fullness under the ball of the foot, associated with pain and a contracture of the second digit. Various options are utilized to allow for customized treatment. Treatment for hammertoes range from fusions, to joint reconstruction with or without implants along with tendon balancing procedures.

Heel spur surgery:
Prior to performing heel spur surgery for plantar fasciitis all other causes of heel pain must be excluded. Most patients do not require heel spur removal. If injections and orthotics fail, patients undergo an endoscopic plantar fasciotomy. A mini incision is created on the inside of the foot. A blade mounted on a camera is then inserted below the ligament. The ligament is then visualized while it is being cut. Patients are allowed to walk immediately after surgery.

Metatarsal lengthening:
Brachymetatarsia or shortened metatarsal may either be congenital or acquired after a traumatic event. Metatarsal lengthening is performed at the center utilizing the latest and most innovative of surgical procedures. The deformed bony or soft tissue structures are lengthened via one of two options. Depending on the length needed, Dr. Pereira will either lengthen the metatarsal with a bone block for an acute lengthening or perform a gradual lengthening utilizing an external fixator. The goal of deformity correction is to allow for a stable extremity in order to walk effectively.

Morton’s Neuroma
Morton’s neuroma is a pathological condition of the common digital nerve between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (“scar”) tissue and the nerve fibers eventually deteriorate. Utilizing minimal incision surgery the neuroma is removed the foot. Patients are allowed to walk almost immediately after surgery. Surgery is performed as outpatient surgery at a hospital

Nerve Surgery
If a nerve is entrapped or damaged patients develop a neuropathy. After an appropriate neurologic assessment Dr. Pereira may perform either a nerve release as in a Tarsal Tunnel release, or nerve repair with or without graft if the nerve is severely damaged. Nerve releases may also be performed at the inside of the ankle, the front of the ankle and around the upper part of the lower leg.

Non Surgical Morton’s Neuroma removal
A neuroma is a pathological condition of the common digital nerve between the third and fourth metatarsals (third inter-metatarsal space). The nerve sheath becomes abnormally thickened with fibrous (“scar”) tissue and the nerve fibers eventually deteriorate. The sensory nerve causing the neuroma is isolated by stimulation with an electrode. The radiofrequency generator then transmits a signal through the electrode, creating a lesion on the nerve in a process called thermo-neurolysis resulting in denervation of the neuroma rendering the same result as a surgical excision but without surgery. The procedure is performed in the office setting and Patients are allowed to walk immediately.

Tendon Repair:
Repetitive injury to tendon may lead to a rupture of the tendon. There are several tendons around foot and ankle. An injury to any of the tendons may lead to a partial or complete tear. Upon appropriate diagnosis the tendon may need to be repaired either via a direct repair without or without graft or a tendon may need to be transferred to take over the function of the injured tendon.

Triple Arthrodesis:
This is a very powerful procedure that is utilized for correction of a multitude of conditions with or without associated arthritis and deformities of the foot. Three joints of the rear foot are fused to obtain a stable foot for ambulation.

Wound Care:
An opening in the skin may necessitate treatment. Dr. Pereira will discuss options prior to beginning treatment. Options for wound care are inclusive to the wound vac, surgical debridement, application of biological grafts in the office, or complex plastic surgical procedures that necessitate skin grafts and flaps performed in the operating room to cover the wound and ensure adequate healing