Well hello and welcome to Help Line.

>> I'm Jennifer Blomquist.

I have the privilege of hosting the program this evening and I'm so glad you joined us.

If you're one of our regulars you know how it goes.

We are live here in the studio and this is a great opportunity to ask our guest questions live during the show.

We have a surgical podiatrist with us tonight.

>> So if you have feet issues or if you have ankle issues, he's your guy and you can ask him questions.

That's why we leave that phone number up at the bottom of the screen throughout the show.

So it's a (969) 27 two zero if you're outside of Fort Wayne it's still a free call.

Just put that 866- in front of there.

And I want to remind you that you have two options when you call in.

We don't just throw you on the air especially if you're a little nervous that you'll talk to a call screener.

A very nice lady is we'll talk to you and you can either ask your question live which I think is a great option because then the doctor can maybe interact with you or maybe he needs to ask you more questions to better answer you.

So that's one option.

But another option that works perfectly well is just tell the call screener what you would like me to ask the doctor and get your question answer that way.

So either way is great but again call sooner rather than later.

We only have them here for about half an hour.

So again we'll keep that phone number up at the bottom of the screen throughout the show.

Let's go ahead and introduce you to our guest.

Tonight is the first time he's joined us.

This is Dr. Steven Douthat and again you are a surgical podiatrist, correct?

>> Yeah.

Thanks for having me.

Thank you so much for coming on tonight.

And he's got two little ones at home so you know how crazy that is.

So we definitely appreciate your time tonight and we thank your wife for her for for loaning you to us of course.

>> But so you you're dealing primarily as a podiatrist with just the foot and also you deal with ankle.

>> Yes.

Yeah, foot and ankle.

So everything basically below the knee is is something that I would treat.

>> Do you find I know we wanted to talk a lot about Bunyan's tonight and so but he has a doctor said if you have something else other than Bunyan's that's obviously a specific topic.

If you have something else ankle or foot related please call them because that is his specialty and so he could at least give you some advice or point you in the right direction if you're having some issues.

>> But we're going to go ahead and start our topic tonight talking about Bunyan's I imagine most people have probably heard of Bunyan's or know somebody who said oh yeah, I have some bunions removed but can you just kind of describe what exactly they are?

>> Yeah.

Yeah.

So there's a lot of confusion about what a bunion actually is.

What what it is thought to be by most patients is a is a bony growth or you know like a tumor essentially.

But what it really is is it's a Emelle alignment of the first metatarsal so the long bone in front of the of the great toe starts to deviate and creates that large éminence and then the big toe then deviates towards the lesser toe and creates the Bunyon.

There are different types of Bunyan's as well.

There's there's an arthritic bunion where the patient actually has bone spurs.

They consider that the Bunyon and then there are also patients that have gout and they develop a buildup of Goudey Toadfish material which is like a deposit that creates an eminence that similar to a bunion as well are they always painful or not?

>> Always actually yeah.

You would find that a lot of patients that have bunions don't even know they have bunions because they don't cause any pain.

It's it's typically painful if the patient is developing arthritic changes and the joint is starting to grind or if the patient is wearing shoe shoe wear that's you know, a little bit tighter and it's starting to cause some friction in there is you mentioned bone spur because my mom had one of those and it was painful.

So is that a totally different yeah, no no.

>> There are bone spurs all over throughout the body but in this instance the bone spurs typically on the top of the great toe joint and it rubs against the shoes and causes grinding sensation in that big toe joint and and that's what causes a significant amount of pain for some patients.

>> What does it I mean I've seen some pictures of it but I've never seen one in person.

So can you kind of describe what it would look like the bone spurs?

>> Yeah.

Yeah.

So if you were to look at the at the foot essentially there's going to be a big lump over the great toe joint and and if you were to touch it you would feel almost like a spike underneath the skin and that's what it would would look like clinically when we actually get into surgery.

What it is it's a buildup of bone that that has kind of accumulated on the top of in this instance the first metatarsal or the or the toe bone phalanx and it's just basically right over the top of where the joint is.

>> Yeah, that was the next I was going to ask you about treatment options.

>> I mean most people want to do whatever is less invasive and I know your specialty in orthopedics.

>> All of your colleagues who've been on in the past say you always start conservatively .

So for for bunion management the vast majority of patients don't require surgery.

We can usually control their symptoms with accommodative shoes.

So shoes that are wider or shoes that are more roomy and allow for that bunion to kind of breathe if you will.

Other things that that may help would be antiinflammatory.

So if the bunion is acutely inflamed after certain activity and the patient takes Antine calamities that can calm it down, other things that you'll see that may help with symptoms would be night splint or sorry like a bunion splint that you would wear at night and try to stretch the toe into a straighter position or padding that you can wear in the shoes or even a toe spacer that that kind of aligns the joints in a little bit better position.

These things they don't fix the bunion but they can kind of give you relief to the point where you you may not require surgery because it makes the joint feel better when you're wearing them.

>> Yeah, I think people like the idea of trying something simple instead of jumping in and doing surgery.

Of course I just want to remind everybody we are we are talking about Bunyan's right now but Dr. Douthat is of a diet just a surgical podiatrist so he knows all sorts of things about ankles and feet and issues you may have so feel free to interrupt us at any time.

We'd love to hear from you again.

The number is (969) 27 two zero .

If you're outside of Fort Wayne put it off make it toll free number by putting in 866- in front of their.

>> So if you try these conservative methods and you're not really finding success or then the next step?

>> Yeah, yeah.

This is it doesn't usually respond well to injections.

It may give you temporary relief but usually the curative treatment is is going to be surgical intervention and that comes in various forms.

So it depends on the severity of a bunion if it's a small Bunyon medium bunion or a large bunion, it depends on the surgeon performing the procedure and their comfort level and the patient's expectations.

So there's everything from a you know, a large incision bunion procedure to to minimally invasive Bunyon procedures which are basically done through through poke holes and that usually results in less swelling, less pain, faster recovery and less stiffness.

So the patients are are typically, you know, very pleased with that procedure.

There are patients that unfortunately can't have that procedure because they may have arthritic changes or or you know, a Goudy deposit that requires a different procedure though.

>> So if you know when you were talking about sometimes they can be kind of big so in a situation like that you actually have to make an incision and then how do you remove it or do you shave?

>> Yeah, yeah.

>> So if the bunion is large there are there are still times that we can do a minimally invasive procedure.

It just depends on on you know, different factors in the radiographs and the clinical exam but the procedure itself typically entails either fuzing two bones together to realignptn itself, shifting the bone into a corrected position and then using screws through small ncisions to to hold it together while it heals after the bone mends it's in the straighter position the bunion is gone and then you just leave the screws in like as if OK. >> I mean I think people are thinking arms and legs to get broken to have the screws in.

>> I didn't know they would do that with yeah yeah with with Bunyan's we have we have you know anatomy specific instrumentation and hardware that that can basically stay in there forever and the patient doesn't know what's even in there most of the time.

>> Can you when you're doing a surgery first of all I don't know if it's common if people would have more than one bunion at a time and can you do surgery on multiple bunions?

>> Yeah.

Yeah.

So if a patient has to Bunyan's meaning both feet typically we don't do them at the same time for safety issues afterwards.

Sure they're in a protected weight bearing device typically after surgery but a patient can have a bunion on the great toe side and then a bunion or a tailers bunion on the outside by the pinky toe and those could be addressed at the same time through similar procedures and the patient could potentially wait there after surgery in a protective device.

>> He was going to ask about the recovery .

So first of all, is this something you do you have to be hospitalized to do or can you do it as an outpatient?

>> Oh, it's an outpatient procedure.

The patient is typically under light sedation anesthesia and they get some form of reginal block and then afterwards the patient is either put into a weight bearing boot or they're on crutches for a very short amount of time and and and that boot protects it while it's mending for the first month or maybe six weeks and then from there they can transition into normal shoes and gradually get back to to their activity.

>> So it's not not it's not it's not no it's not typically crutches for months and months like the horror stories of the you know, the eighties and nineties that that a lot of patients have heard.

>> Yeah.

Oh yeah.

Things have changed so much and even just the outpatient care I mean things where you think you'd be put under you know, put under anesthetic and yeah you're pretty much no it's always it's it's day surgery and 30 minutes later you're you're in the recovery room so pretty quick.

>> All right.

Well that's good news.

Most people like to have it done and over with quickly so yeah.

Yeah we did get a call from someone named Sally and she wanted me to ask the question for her.

>> So Doctor, she wants to know what is the best thing to do for nail fungus?

>> Yeah.

Yeah.

So nail fungus is is a tricky thing to treat.

There are topical and oral antifungals for toenails typically the topical are are not as effective as the oral antifungals and that's usually because of the patient abandons treatment because it requires eight to ten months of treatment and people get sick of painting something on their toenail every day for you know, eight to ten months and then there are oral pills.

The the oral pills are taken once a day for about 90 days.

The only problem with the oral pills is they're metabolized in the liver and if a patient's on cholesterol medication or if they have any type of liver issue, we don't like to prescribe it because it can it can kind of cause the enzymes to raise up a little bit.

But the pill is the most effective treatment unfortunately in that in that instance for the side effects.

>> Yeah, I didn't know we've had some of our kids have dealt with warts which are so just so stubborn so I didn't know like and I've heard the same of nail fungus to that kind of stubborn I once I mean once you get rid of it can it come back pretty.

>> Yeah it does have a high recurrence rate.

You know there's a reason that that the that the toenail fungus set in in the first place that's usually you know either the patient's nails have a little bit of of kind loosening so the moisture can accumulate underneath there or they are, you know, someone that has more sweaty feet and unfortunately that isn't cured with the nail fungus so it can recur.

>> I just know it looks ugly.

Yeah.

I mean it's you know, most people in the summertime when you want to maybe wear Sam Yeah.

>> And it's it's a little it's it's a cosmetic issue most of the time it doesn't typically cause pain or or you know I can't go systemic so so it's more of a cosmetic issue.

>> All right.

Well Sally, thank you so much for that call.

And we actually have somebody else calling it right now.

She's going to ask her question live, I believe.

>> And are you still on the line?

I sure am.

Oh, thank you for waiting.

You have a question for Dr. Duffett?

>> Yes.

I had knee surgery two years ago this January where I had a complete knee from black the arthritis and bone on bone this summer my the top of my left foot where I had the surgery on my left leg I could tell that there was a little swelling and there was pain on the top of this left foot which now has increased and has gotten worse over the months where it sometimes is really painful to even stand or walk.

And I'm wondering if it's related to my knee surgery or if it's something completely different but it's almost getting to be a quality of life issue for me because it's just too, too hard to stand on my feet and walk a lot.

>> Oh yeah yeah yeah.

So it sounds like in this instance you may have had pretty severe knee pain ahead of the knee replacement surgery and then after the knee was repaired it may have unmasked the foot problem.

I don't know that it's necessarily related to the to the knee surgery but I would suspect that if you were to have an X-ray it's sounds like you might have what we call midfoot arthritis or arthritis in some of the joints in the middle of the foot.

So that would be something I would definitely check into a lot of times arthritis of the midfoot is treated with anti inflammatories nice stiff shoes to prevent flexion of the bones of the foot and much motion through those arthritic joints as a first line treatment and and there are procedures that can be done injections, things like that for midfoot arthritis as well if that if that happens to be you know, what's what's going on and I don't know if you're still on the line but did you did you want to ask Doctor anything else?

Yeah, I just wondered about my Barracas vein.

Would it have anything to do because I do have really bad varicose do you think it would have anything to do with that either?

>> You know, sometimes patients that have varicose veins they do they do end up capturing a lot of edema in the foot because of gravity it likes to pool and accumulate in the foot and that edema or swelling can can lead to increased pressures in the soft tissues of the foot and that that could lead to to foot pain as well so that that could be something that's leading to it for for edema or varicose veins.

I'm sure you're aware but a lot of times the main the mainstay treatment would be compression stockings or or even diuretic or water pills to to help get rid of some of that fluid and that may alleviate some of the pressure in the soft tissue envelope of the foot and relieve some pain as well.

So it sounds like she should start by trying to go see somebody and see about an x ray that would be the first yeah.

>> Yeah.

First first step is have it evaluated and see which direction to go with it right now and thank you so much and I hope it all works out.

>> It sounds like if that you know if it's some of the issues you've mentioned that there are some things that can be done to alleviate pain because it sounds like she's in terrible pain.

Yeah.

Yeah.

I wish or wish her well for sure.

For sure.

We had another call and she wanted me to ask the question for her it was Catherine.

So she wants to know what would you suggest for periodic neuropathy in the foot or in the feet a company accompanied by pain.

Yes.

So that's a good question.

The first thing with neuropathy is is really understanding what what the cause of neuropathy is.

So neuropathy is is a blanket diagnosis of nerve conditions, nerve pain a lot of times neuropathy in the feet.

It could be related to diabetes.

It could be related to alcohol use.

It could be genetic.

It could be you know, a lumbar or a spinal impingement leading to nerve impingement that's leading to the foot and caused that foot pain.

So step number one is is understanding where it's coming from and then step number two would be treating either that that causative factor or making a patient more comfortable with medication like Neurontin which is Gabapentin Lyrica and a lot of times a pain specialist it's involved in and can kind of down regulate the nerve pain.

There are also topical medications that that can be used for for neuropathic pain that almost desensitizes the nerves a little bit.

It's it's got capsaicin so like red pepper, red hot pepper in it and that can be spread on the foot and almost cause a burning tingling sensation and then you wipe it off and the thought is that may desensitize the skin and kind of down regulate some of that hyper feedback that the patient is getting from the the neuropathic symptoms with neuropathy with a patient like that get any benefit from certain kind of footwear or like a prescription even type of shoe.

>> Yeah, a lot of patients that have neuropathy they happen to be diabetic and and in those instances it's actually wise that the patient get into, you know, a certain type of shoe with an insert that's custom molded to to alleviate pressure points.

The problem with neuropathy is if a patient is walking and they're rubbing against something and they don't have that that proper nerve feedback, they could develop a sore abrasion and develop an infection without even knowing it.

So so there are shoes and inserts specifically designed for those patients.

>> Yeah, I guess I want to I want to also point out, you know, we've had some other of your colleagues in podiatry on the show and I know a lot of them have said hey, at some point don't do these over the counter things when you walk on the scanner and it's like oh this is the kind of answer you give your shoe.

You know, a lot of them have said that if you're having some serious pain it's really best to talk to somebody who really knows what they're doing.

>> Yeah, yeah, definitely.

You get what you pay for sometimes you know, if you step on a monitor and it tells you what inserts are going to cure your back pain and yeah it might be might be too good to be true.

Yeah yeah.

For five ninety nine yeah that's probably got to be the best best outcome.

We are very popular tonight so we have another person who called in a gentleman named Wesley but he wanted me to ask his question for him so he is asking are there any treatments that are not medications or ointments?

>> Oh that can help with the toenail fungus.

Yeah so there's a lot of anecdotal little discussion about different treatments for toenail fungus.

So things that I hear but I don't recommend because there's not enough literature to really prove it.

>> But a lot of patients will use like tea tree oil or they'll use Vicks Vapor Rub and and what that does is it almost softens the nail which then allows the person to kind of almost dig out some of the nasty debris.

>> So that may help with it.

It's just not something that has been has been studied in in.

>> Yeah.

So for the hospitals that are that are, you know, actual medications, those are probably going to be a little bit more effective as far as as far as you know, less invasive treatments than than like the pill.

>> Sure I do.

Most people if you get that toenail fungus I mean I just look at them.

They look so dry and you know and just Crumbley almost did I mean does anyone ever like lose the whole nail from a fungus?

>> Would that would that happen?

Usually the nail gets gets quite thick and then and then the patient's getting some rubbing on the shoes that they come in and a lot of times we'll we'll do a nail avulsion or remove that toenail for the patient and and there's ways that we can make it so the toenail never grows back again so they don't have to deal with any toenail whatsoever.

And you know, those patients are the ones that you're describing with the crumbling thick kind of you know, nasty toenail.

>> Yeah.

Now we just I was we were talking before the show one of my boys had to have a strip of toe of the nail removed from each of his big toes or a great toe as you say.

>> And I was horrified that it would be terrible.

But actually I mean they gave him so much relief because he was always getting infections from you know, it was there was so much nail and the skin would grow over it like any toenail.

>> So it it really wasn't that bad and now he's pain free so yeah.

Yeah it's it's a lot simpler of a procedure than people think.

Yeah.

To have a you know Naperville's and or a matrix ectomy where we you know kill it off if you will grow back.

Yeah no it was quick that's for sure.

So let's see another person called in I wanted to ask a question we may get back to the Bunyan's at some point but if not we appreciate the calls.

The questions are great Salina's asking what does the minimal or what does the minimally invasive surgical technique for bunion removal look like?

>> Yeah so so basically what it is is it's a it's a procedure.

The patient goes in to the operating room under sedation anesthesia.

They get some local anesthetic to numb up the area where we're working.

We make a poke hole right at the the neck of the metatarsals so right where that protuberances on on the metatarsal and we actually use a specialized BRX that cuts the bone.

We then shift the bone over to get it into straighter these small titanium screws- into the bone to hold it in place.

We bandage them up a lot of times I actually do it with no stitchs.

So the patients don't even have stitches in certain instances and then we we put them in a small surgical boot or a surgical shoe and let them wait there to tolerance afterwards.

A lot of times you'll want to put weight on your heel afterwards and keep it off from the ball your foot but you wear that that surgical shoe or surgical boot for somewhere between four and six weeks and then you're back into comfortable sneakers and and then running, jumping, kicking somewhere between eight to 12 weeks you're back at it if if if everything heals accordingly.

>> Yeah, that was her second part of this question was the post.

So I was just wondering does anyone that has bunion removal would they ever need to do any physical therapy or do you give them certain exercises to do so?

>> That's a that's a great question.

The traditional bunionectomy where we're doing a larger incision, the patients form adhesions a lot more so they get a lot more stiffness.

So that is that is something that requires physical therapy, lots of range of motion exercises and joint mobilizer type techniques.

The minimally invasive technique doesn't violate the joint capsule itself whatsoever or so you don't form those adhesions.

So the patients range of motion is great right after surgery and they can they can bend the toe just fine.

And if physical therapy is not necessary unless you know, eight to 12 weeks later the patient is is not, you know, getting their gait back accordingly and they just need a little help with gait training but most of the time they don't require physical therapy.

>> Yeah, that sounds great.

I think a lot of people get bummed because some of the some of the orthopedic surgeries require months of physical therapy.

I can be a for so I think somebody is going to ask a question like Connie, are you still there?

Yes, I oh thank you for waitig.

>> Go ahead with your question.& Uh, OK.

I had a spare take it off like every nine months it's formed a scar and I have to pull it and peel it off just a heel heel from the inside out.

>> So in your case it it may actually be a a callus that keeps reforming at your surgical scar when you're describing peeling something out it sounds like you might be developing a a thickened callus over your incision site and that that Kallus builds up to a point where it then is ready to sluff off when you remove it and then it forms again after more friction occurs.

>> Your shoes is what I'm speculating.

Is that something should she maybe have a return with with the physician that yeah I would I would definitely follow up with the surgeon or a surgeon to take a look and just make sure that there's nothing else going on that that might be leading to some buildup of skin or potentially I mean it could even be a small wound that continues to drain from time to time that may need to be addressed.

>> All right.

Sounds good, Connie.

Thank you so much for your question and many thanks to everybody who called in tonight.

Great questions.

I appreciate it and certainly appreciate your time.

Again, this is Steve and Dr. Steven Douthat, a surgical podiatrist.

>> So nice to have you on.

So thank you for having me.

It was it was great PERTZYE he was all there is it is his first time doing it.

I said it'd be a piece of cake so it was great.

He did a great job.

Hey and this is my last program until the end of the year.

So I just want to wish everybody a merry Christmas and a very happy New Year.

I hope you get to spend a lot of time with family and friends and stay healthy.

So take care.

We'll see you in the New Year.

But there is another HealthLine coming up next week.

>> Take care.

Bye bye