Areas of Practice & Expertise
Arthroscopy
Arthroscopy is an advanced surgical procedure used to treat orthopaedic conditions which offers less risk and remarkable results for patients. This procedure is also known as arthroscopic surgery. Surgeons perform this minimally invasive surgical procedure to correct orthopaedic joint trauma/conditions by inserting an arthroscope into a small incision in the compromised area.
Lateral Ankle Stabilization
Your ankle is a hinge joint that allows motion up and down, and from side to side. Your foot and ankle have several ligaments. These are strong band-like structures that keep the bones in your ankle and feet tightly connected. On the outer side of your foot, you have several ligaments. These include the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). These help keep your ankle and foot steady when you walk. If you have had repeated ankle sprains or if you have certain foot deformities, your ligaments can start to get weak and loose resulting in damage to the joint. If this happens, your ankle may become unstable.
During lateral ankle ligament reconstruction, the surgeon makes a small incision on the outside of your ankle. This is done while you are under general anesthesia. Then your surgeon repairs one or more of the ligaments on the outside of your foot.
Total Ankle Replacement
Total Joint Replacement is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal or plastic prosthesis.
In a total joint replacement (also called arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components. Dr. Wolfe specializes in total ankle replacement.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total ankle replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Minimally Invasive Surgery
Minimally invasive surgery (MIS) is a technique used by foot and ankle podiatric surgeons to correct specific foot and ankle conditions with very small incisions. This technique has gained attention among surgeons and patients alike due to its reported faster recovery time, smaller scars, and reduced postoperative opioid use.
Common foot and ankle conditions that can be treated using minimally invasive surgical techniques include bunions, hammertoes, big toe arthritis, and metatarsalgia.
Lisfranc Ligament Injury
The Lisfranc ligament runs between two bones in the midfoot (middle of the foot) called the medial cuneiform and the second metatarsal. The place where these two bones meet is called the Lisfranc joint. The name comes from French surgeon Jacques Lisfranc de St. Martin (1790-1847), who was the first physician to describe injuries to this ligament.
Tearing of the Lisfranc ligament and other ligaments around the Lisfranc joint can lead to instability and disruption of the joints in the middle of the foot. The goals of Lisfranc surgery are to put the bones back into their original position and restore the foot's normal alignment.
Your foot and ankle surgeon may recommend surgery for a Lisfranc injury if your midfoot joints are not lined up anatomically. Most commonly this misalignment is identified on X-ray; however, CT and MRI scans also can be helpful in diagnosis. Surgery will realign and stabilize the misaligned joints. Some injuries with noticeable cartilage damage may require fusion of the joints.
Advanced Foot & Ankle Reconstruction Surgery
Foot & ankle reconstruction is a surgery performed to correct the structures of the foot and ankle to restore the natural functionality that has been lost due to injury or illness. Ideally, any foot surgery for reconstruction is done to improve the appearance and function of the foot so that patients can maintain their quality of life
The foot is formed by several bones, ligaments, joints and muscles, which function collectively to control the various movements like walking and running. This complicated structure of the foot permits them to resist heavy forces every day. As the feet are a common area for wounds and injuries, they are susceptible to various mistreatments in the form of ill-fitting shoes, sports injuries, work-related trauma, or the strain of walking. Various outside forces tend to harm the feet and cause pain and discomfort.
Indications for Reconstruction:
A variety of reconstructive procedures are designed to treat many foot disorders and restore your foot back to its original health and function. Following are the indications:
Common foot ailments like bunions or hammertoes
Postural deformity such as severe flat feet
Pain while walking on hard surfaces
Difficulty wearing shoes
Problems with standing or other movements of the foot
Fractures sustained as a result of accident/trauma
Athletic injuries like Achilles tendon tears, foot/ankle fractures, ligament injuries and several others
Plantar fasciitis, a common cause of heel pain
Heel and bone spurs
Joint or bone deformities due to arthritis
Infections
Tumours and lesions
Metabolic disease such as diabetes
The primary objectives of foot reconstruction are reduction of pain and restoration of function and appearance. The surgery to be performed depends on several factors such as the age of the individual, type of foot disorder, and severity and duration of the symptoms.
Diabetic Limb Salvage
Whether Diabetic limb salvage is the term used when doctors from multiple specialties work together to prevent leg amputation and limb loss for their patients. About 10% of the United States population suffers from diabetes. Keeping these patients healthy and active is the goal of diabetic limb salvage.
Some key facts on Diabetes and Wounds
15% of patients with Diabetes will develop a foot ulcer in their lifetime
12 weeks – the average time to heal a diabetic foot ulceration
43.4% – the 5-year survival rate following a leg amputation due to a diabetic wound
Diabetics often experience issues with blood circulation, muscle contractions, and nerve response. As a result, their bodies are more prone to developing wounds and sores on the feet and legs. They have a hard time healing wounds that would otherwise be considered minor. The most common lower body wounds that diabetic patients experience are foot ulcers and subsequent infections to the surrounding skin and underlying bone. The progression of these infections leads to more than half of the non-traumatic leg amputations that are performed by doctors each year. Another diabetes-related issues that can lead to amputation are peripheral neuropathy (when the nerves that carry messages to the the central nervous system is damaged or diseased), and peripheral vascular disease, or PVD for short (when the blood vessels become narrow or blocked, limiting circulation).
Amputation is the last case option in patients with chronic ulcers and infections that do not respond to non-surgical treatment. Limb salvage is not a specific treatment, but rather a blanket term encompassing all procedures, interventions, and treatments that attempt to preserve the limb and retain limb function.
Diabetes is a complicated disease that requires a team of professionals to treat and in the case of diabetic limb salvage, multiple different physicians and specialists will be consulted to address treatment and recovery.
In order to determine the extent of your condition and to help put together an accurate diagnosis, doctors may schedule an Xray, an MRI, an ultrasound to assess blood flow, or possibly an angiogram, which is a special type of x-ray that involves injecting a dye into the bloodstream to help illuminate any existing blockages.
There are several different treatment options commonly used to help avoid amputation:
Stenting is when a small tube is placed in the artery to aid blood flow
Bypass is when a vein is moved, or a tube is inserted to circumvent the blocked area and bring blood to where it is needed
Atherectomy is when plaque is removed from a narrow artery
Angioplasty pushes the plaque against the walls of the artery opening the blocked area
Surgical closure or offloading of the wound area
If the infection is indeed the culprit, debridement is the term used for the removal of damaged or infected tissue.
Outside of surgery, there are a few non-invasive treatment options that will likely be employed before an operation is considered, some of these include:
Appropriate Wound Care
Biologic agents in the clinic to help with the healing of wounds
Glycemic control
Gait adjustment
Orthopedic inserts or customized footwear
Casting to protect the limb
Hyperbaric oxygen therapy