Blog

How to Identify and Treat a Sprained Ankle

  • sprained ankle

How to Identify and Treat a Sprained Ankle

Do you think that you sprained an ankle?

Is your ankle swollen and bruised? Can you place weight on it?

These are just a few of the symptoms of a sprained ankle. In fact, 2 million Americans suffer from an acute ankle injury each year.

Ankle injuries account for roughly 20% of all injuries suffered in amateur sports.

If your ankle injury is not properly identified and treated, it could lead to chronic issues.

Read on to learn how to identify a sprained ankle and the anticipated treatment plan for such an injury.

How do Sprained Ankles Typically Occur?

Sprained ankles frequently happen while running or playing sports. The injury itself occurs during the rapid movements involved with these activities.

A sprained ankle can also happen accidentally through a misstep.

More specifically, the injury is sustained when the foot is planted and the ankle rolls over outward or inward.

When the ankle rolls over, ligaments on the outside or inside of the ankle stretch and tear. In some cases, you may physically feel the tear or hear a pop.

This will cause immediate and excruciating pain.

What are the Symptoms of a Sprained Ankle?

You will know the second you sprained an ankle. In addition to the pain, walking will be a challenge as you will be hard pressed to put any weight on the ankle.

Shortly after the injury occurs, swelling will begin with bruising to follow. Routine movements may be painful and the ankle tender to touch.

What Should you do Immediately After the Injury?

If an athletic trainer is present, the first course of action may be to apply a compression wrap. This is intended to limit swelling, which in turn, may help the ankle feel better later.

Without the help of a trainer, a common mistake that is made is removing the shoe. On the other hand, you should tighten the shoelaces to apply compression. This works especially well with high top basketball shoes.

Once you are in a position to rest, it is time to ice and elevate the ankle. When you aren’t icing, compression wrap is still beneficial.

Ultimately, the best way for the ankle to heal is to stay off of it.

When Should You Seek Medical Attention?

The severity of the ankle injury will dictate whether a visit to the doctor is necessary. If the pain persists and is not improving with ice and rest, medical attention is warranted.

At this point, there is a potential that the ankle is fractured and not sprained. X-rays may be required on the ankle to rule out a fracture.

If an ankle sprain is confirmed, the doctor may recommend wearing compression socks or an ankle brace while working or doing light activity.

Wrapping It Up

As alluded to earlier, the best way to recover from an ankle sprain is rest. Staying off the ankle will allow the body to naturally repair the torn ligaments.

Ice, compression, and elevation are also part of the treatment process.

If you have any additional questions about sprained ankles, please do not hesitate to contact us for assistance.

4 Diabetes Products to Help Relieve Your Foot Pain

  • diabetes foot pain

4 Diabetes Products to Help Relieve Your Foot Pain

As a diabetic, you have to be constantly mindful of what you put into your body. And, if you have some form of neuropathy, you need to stay on top of managing your symptoms. 

You’re not alone in managing neuropathy. About 60-70% of diabetics have some form of neuropathy according to the National Institute of Diabetes and Digestive and Kidney Diseases. 

If you have peripheral neuropathy, you likely have pain in your fingers, legs, and feet. You can usually manage the pain by getting your diet under control, exercising, and quitting smoking. 

But, there are some days when even naturally managing your diabetic foot pain isn’t enough. On those days, you need diabetes products to help relieve your foot pain.

Here are some products to help treat your foot pain.

Diabetic Shoes

When you have peripheral neuropathy, you should avoid walking around barefoot. The risk is too great that you will open a new wound on your foot and not realize it.

Diabetic socks are made of anti-bacterial fibers which are designed to wick away moisture from your feet. They also help reduce rubbing and irritation which can cause blisters.

Diabetic shoes and insoles mold to your feet to provide exactly the right support. Having the right shoes reduces pinching which can lead to foot ulcers.

Compression Socks and Stockings

Diabetic foot pain is caused largely by the weakening of the veins in your legs. The vein walls become too loose to let blood circulate back up your legs, so unoxygenated blood pools in your feet. 

Compression socks and stockings put a slight pressure on your legs, and by extension, your veins, to give them the support they need to carry blood from your feet to your lungs.

Like many diabetic products, there is no one size fits all solution for compression socks. Speak to your doctor about the level of pressure you need in compression socks. 

Capsaicin Cream

A capsaicin cream is a topical treatment applied to the skin. The main ingredient in capsaicin creams is a compound found in hot peppers. 

When applied to the skin, capsaicin first stimulates the nerve endings, which can cause a brief jump in pain. This stimulation is followed by decreasing intensity of the pain as the capsaicin starts to block signals in the nerve endings.

In a study of 252 individuals, 58.4% of patients reported an improvement in pain relief by applying a capsaicin cream. 

While you can pick up a capsaicin cream at your local drugstore, check with your doctor before using one. Capsaicin can react with other drugs and irritate your skin. 

OTC Pain Relief

For days when you have mild nerve pain from diabetes, over the counter pain relievers are a good option for finding relief. Many diabetes patients will turn to their regular painkillers like Advil or Tylenol. 

If you find you’re taking these OTC painkillers too frequently, you should speak to your doctor about other medications you can take. If your pain level is high, your doctor might prescribe an antidepressant or anti-seizure medication, both of which help with pain management. 

Ask Your Doctor About the Best Diabetes Products For You

Before you select new diabetes products to try, you should consult your regular physician and podiatrist first. 

If you’re looking for expert advice on incorporating new diabetes products into your treatment, schedule an appointment with us today.

Why Do My Heels Hurt? Questions For Your Doctor

  • why do my heels hurt

Why Do My Heels Hurt? Questions For Your Doctor

Are you feeling pain in your heels when you walk or run? Is there a distinctive tingling or burning in your pedestrian support system? 

Heel pain can be incredibly obtrusive and can be debilitating to your day to day. There are a plethora of problems that involve the feet as we get older. 

The good news is that many of those problems actually have solutions and explanations. If you’re asking yourself, “Why do my heels hurt?”, then consider a few of these questions and do some prep-work before seeing your doctor.

Here’s a list of questions for your doctor regarding heel pain:

1. What Is The Right Kind Of Shoe For Me

Whether you’re a gym fanatic who runs a lot or live in a big city and walk plenty, a good pair of shoes can save you. Different shoes are made to create support for different parts of your foot based on the activity of the user. 

When choosing a shoe, it is important to take into consideration every detail of how the shoe is constructed and where the support system within the shoe lies. Some people prefer the more barefoot feeling approach, while others require heavy cushion under their feet on a daily basis. 

Whatever your activities are, asking “Why do my heels hurt?” on a daily basis means you probably need new shoes. A doctor or foot specialist can point you in the right direction. 

2. Ask “Why Do My Heels Hurt?”

Is It Because of Plantar Fasciitis?

Plantar fasciitis occurs when there is extreme overuse of the heel and could leave you asking “Why do my heels hurt?” It isn’t completely uncommon either, as 1 in 10 people will develop plantar fasciitis in their lifetime. 

If left untreated this can become a major issue for your feet. Ask your doctor about plantar fasciitis and they’ll be able to tell you if you suffer from it. If it isn’t taken care of, it can make for a very serious situation and even lead to heel spurs.

3. Ask About Heel Spurs

Heel spurs are bony structures that grow from the heel bone area. They create major pain in the heels. If you’ve been dealing with heel pain for a long time and possibly plantar fasciitis but didn’t know it, you may have created a space for heel spurs.

Heel spurs often require surgery and can slow your life down for some time. The key is to have your heels evaluated before it is too late.

4. Do I have Bursitis? 

Bursitis is the deepening of the bursa. In the foot atrium, there is a pillow-like sac that bonds with the bone or curves around it. The atrium is like a bean bag that gives cushion to the bond and the bone.

If there is an abrasion or heavy burden consistently on it, the sac will become afflicted and unhealthy, which creates a lot of pain. 

5. Do I Walk or Run Correctly?

Yes, there is a proper way to walk, run, and even stand. If you’ve got poor running posture you can absolutely be putting more pressure than is necessary on your heels. 

With an evaluation from your doctor or physical therapist, you can learn to evenly distribute your weight and pressure when walking or running. 

For more info on optimal foot and ankle care, call our office +1-626-385-3338 – or – request an appointment!

 

Ingrown Toenail Surgery- What to Expect

  • ingrown toenail surgery explained

Ingrown Toenail Surgery Explained- What to Expect

Having an ingrown toenail is extremely painful, and most people try to handle it themselves. However, constantly digging at your toenail at home can do additional harm.

You may think that ingrown toenail surgery is unusual, but it’s actually a common procedure. If a nail will not respond to the usual treatment, surgical treatment is recommended.

If your doctor has told you that you need surgery on your ingrown toenail, you may be nervous. It helps to understand why surgery is prescribed and what you can expect.

Why Ingrown Toenail Surgery?

An ingrown toenail is a common painful condition. Generally, it occurs on the big toe. The nail grows into your skin instead of growing outward normally. Ingrown toenails are one of a number of common foot problems.

Ingrown toenails generally occur as a result of improper shoes or toe injuries. It may also occur due to genetic conditions, aggressive pedicures, or split nails. Traditional treatments for ingrown toenails include foot soaks, nail trimming, and good foot hygiene.

Unfortunately, ingrown toenails often come back again and again. There’s a risk of infection as well. These risks lead many doctors to recommend toenail surgery to correct the problem permanently.

You Won’t Need Anesthesia

Most ingrown toenail surgery is a quick procedure done at a podiatrist’s office. You will not be put under general anesthesia. Instead, you will be given an injection that will numb your toe.

The injection will sting and burn for a few seconds, but after that, there is no pain. A rubber band tourniquet is applied to the base of the toe to reduce bleeding during the surgery. The fact that you won’t be knocked out for a major surgical procedure is a significant relief to most patients.

A Section of Toenail Will Be Cut Away

Rather than cutting only the edge of the nail, a podiatrist will cut a larger section of the toenail away. Only the side near the site of the ingrown nail is affected.

A deep cut is made, and forceps are used to pull away the nail. This exposes the skin below the nail, or the nail bed, in that area.

Once the nail is cut away, the doctor will use cotton swabs to clean the area. The cleaning solution will repeatedly be applied for several minutes to clean the site of the surgery completely. Afterward, a bandage will be wrapped around your toe.

You Can Walk Right After Surgery

If you’re concerned about having trouble walking, you don’t need to worry. After bandaging, you will still be able to wear shoes and walk normally. You can remove the bandage after two days.

You will have to wash the surgical area every day, and you may be given antibiotic ointment to prevent infections. You may have minor throbbing or pain after the anesthetic wears off, but the discomfort is minimal.

The solution is permanent. Ingrown toenail surgery is a common, well-proven procedure that can end your ingrown nail issues for good. If you’re interested in learning more about common foot problems, and how you can handle them, Call our office +1-626-385-3338 – or – click here to request an appointment!

5 Tips for Giving Yourself A Diabetic Foot Exam

  • diabetic foot exam image

5 Tips for Giving Yourself A Diabetic Foot Exam

Over 29 million Americans have diabetes. Those with diabetes must be sure to take care of their health and watch for any complications.

One concern for those living with diabetes is complications with their feet. Diabetes can lead to nerve damage leaving one unable to feel hot or cold. This lack of sensitivity can lead to injuries very easily.

This is why conducting a diabetic foot exam is crucial.

Are you living with diabetes and trying to best take care of yourself? Read below for five tips for giving yourself a proper foot exam!

1. Find a Comfortable Position for Giving Yourself a Diabetic Foot Exam

In order to properly assess your feet, you need to get in a comfortable and stable position. If you have poor flexibility or excess belly weight, you may have difficulty seeing your feet. If this is the case, ask a family member or caretaker for help.

Try sitting on a bed or toilet for stability. Make sure there will be room in front of you to pull your leg up on top of the other one. If you recently showered, be sure to completely dry your feet before beginning the exam.

2. First Focus on the Bottom

Gently move your ankle so the bottom of your foot is visible. If you are unable to achieve this position, try using a mirror.

Checking these areas will help avoid many foot complications possible with diabetes.

Scan the balls of your feet for bumps or rough texture. Check the soles for bumps and lumps which could signal bone or muscle problems. Also be sure to check your heels. Keep a look out for dry cracked skin.

Be sure to moisturize with lotion. Even small cracks can become infected.

3. Get Touchy Feely

During your diabetic foot exam, make sure to feel your entire foot. Pay attention for any drastic temperature differences or bumps. There are foot infrared thermometers that can be helpful in detecting circulation issues you may be unable to see.

Make sure to note any tenderness or pain you notice here. There are many options for dealing with diabetic foot pain.

4. Use your Eyes

Make sure to a visual inspection of your feet. Again, note any bumps or areas that look abnormal. Keep an eye on any scabs or rough textures.

Decreased blood flow can make skin look thin or shiny so be sure to note any overall skin appearance changes.

5. Pay Attention to Toes

Make sure your toenails are a normal color. Spread your toes with your fingers to check in between for any areas or red skin or ingrown toenails.

If you haven’t had previous complications, try doing an exam weekly. But if you have a history of complications, be sure to do an exam every day. This will help you keep a close eye on any issues.

Follow these five tips and you will be on your way to your own diabetic foot exam. Still have questions or concerns? Call our office +1-626-385-3338 or if you prefer to reach out to us via email, we will be happy to help!

Bunion Surgery: 5 Most Common Questions

  • Bunion Surgery Schematic

5 Most Common Questions About Bunion Surgery

Bunion surgery is typically a surgical procedure to correct a deformity near the big toe on your foot. This procedure is usually recommended when other treatment options fail to relieve the symptoms of a bunion.

Before undergoing this procedure, it helps to learn more as possible to ensure it’s the right treatment for you.

In this post, we’re are going to share some of the common questions about the surgery.

1. Do I Need the Surgery?

In most cases, if the bunion is not painful, then surgery is not necessary. Even though sometimes bunions increase in size, doctors don’t recommend surgery as the first treatment option.

Instead, wearing protective shoes is the ideal measure to slow the progression of a bunion’s size. Keep in mind that the surgery should not be performed for cosmetic reasons. Sometimes there can be an ongoing pain even when there’s no bunion.

2. What Kind of Preparation is Needed?

Before the bunion surgery, you may need to undergo several tests to check your overall health. Some tests may include a  cardiogram to check your heart’s function, X-rays to assess your lungs, and blood and urine tests to see if you have any underlying conditions.

If you’re taking medications, such as aspirin or other blood thinners, you’ll need to stop taking them a few days before surgery.

3. Are There Different Surgical Procedures for Bunions?

It’s helpful for your doctor to explain the different bunion surgery options you have. This helps in recommending the right procedure for you. Typically, there are three common surgery techniques:

Bone cutting

Podiatrists use this method to cut the deviated bones. It also changes the bone shape to ensure a correct position.

Bone fusion

In this procedure, the doctor joins the non-essential joints to realign the entire bone of the foot and remedy the deviation.

Bunion shaving

This is recommended for small bunions, and it involves removing excess bone from the inside of the bone. Ligament repair is also necessary here to ensure proper to alignment.

4. What Is the Expected Recovery Period?

Generally, it depends on your bunion size and the type of surgery selected for you. For most patients, this takes about six to eight weeks for the bones to mend after the procedure.

Most patients usually resume their normal routine and activities three months after the surgery.

It’s not recommended to drive until the surgery heals, especially if you’re using restrive devices such as casts and boots.

5. What Is the Cost?

The charge for bunion surgery depends on the size of your bunion and type of procedure. In general, you can expect a cost range of $3,000 to $5,000. Your doctor will provide more information on the cost during your initial visit.

Since the surgery is a medical procedure, most insurance plans usually cover it. However, if the purpose of the surgery is to improve the foot’s appearance, then this may not be covered. Your insurer and doctor will help you understand your options.

Bunion Surgery – The Bottom Line

The surgical approach for bunions varies depending on the severity of the condition. As a patient, you should only consider this treatment if taking anti-inflammatory medication, using toe splints, and wearing wider shoes fail to relieve your bunion.

Also, don’t wait too long as going without treatment can lead to other foot problems and deformities. If you have any questions, call our office or if you would like to request an appointment

 

How to Get Rid of Toenail Fungus Naturally

  • how to get rid of toenail fungus

How to Get Rid of Toenail Fungus Naturally

Every athlete knows how gross foot fungus can be. It’s just part of the game if you participate in an active lifestyle.

But aside from its unsightly appearance, it can result in an infection, keeping you sidelined for way too long. Whether from sweat or swimming, toenail fungus can be painful and embarrassing.

That’s why you’ll want to take care of any fungal growth as quickly as possible. But it doesn’t always take a trip to the dermatologist or podiatrist to get rid of pesky fungus!

If you’re wondering how to get rid of mild toenail fungus at home, look no further! Here are some simple home remedies that you likely already have.

How to Get Rid of Toenail Fungus

What to Look For

The first step in figuring out how to get rid of toenail fungus is knowing what to look for.

If you’ve noticed your toenails looking yellow, you may have a fungal presence. 

Other symptoms include:

  • Peeling or cracked feet
  • Itching and burning
  • Painful blisters

If any of these symptoms sound familiar, you may Athlete’s Foot or a similar fungal strain.

Apple Cider Vinegar

Apple cider vinegar seems to be a key ingredient in nearly every home remedy out there.

It’s a great choice for fungal infections because of its acidic properties. The acidic nature prevents any spreading throughout the rest of the foot.

Take about a half-cup of water and mix it in with your apple cider vinegar. Then, soak your affected toe/foot for around a half hour.

Repeat this process once per day for as long as the fungus persists.

Tea Tree and Olive Oils

Tea tree oil is fantastic because it’s an antiseptic. While it won’t necessarily prevent any spread, it will keep the area clean and begin to weaken the fungus.

Mixing in a little bit of olive oil can increase its antiseptic properties drastically.

Take 1 teaspoon of olive oil, then mix it with a few drops of tea tree oil. You’ll likely notice the fantastic smell right away.

Take a Q-tip, toothbrush, or similar device and dab the liquid solution on your toe. Leave it to soak for around 10-15 minutes. Repeat a few times each day for several weeks.

White Vinegar

Like apple cider vinegar, the acidic properties of white vinegar are fantastic for home remedies. Not only will it fight infection, but it restores your skin’s natural pH balance!

Mix a few tablespoons of white vinegar with a half cup of warm water, then soak your toe for 15 minutes. Repeat this process 2-3 times a day for several weeks.

Baking Soda and Epsom Salt

One of the first remedies a podiatrist will likely give you for any type of foot infection is Epsom salt. It’s a wonderful, soothing solution that eases any pain you may experience after an injury.

When mixed with water, it changes into magnesium and sulfate, which your skin absorbs.

Take half a cup of Epsom salt, mix it with 4 or 5 tablespoons of baking soda, and add a cup of warm water. Soak your foot for roughly 20 minutes.

Tips to Prevent Foot Fungus

  • Wear close-toed shoes around moist areas.
  • Keep feet dry.
  • Change socks frequently.
  • Wash and dry your feet after exercise.

We understand that Athlete’s Feet and toenail fungus can be pesky, to say the least. If these tips don’t work for mild symptoms, your symptoms appear to get worse, or you’re still not sure how to get rid of fungus, contact us today

From diabetic foot care to ulcers, we can treat it all. Schedule an appointment and let us get you back in the game.

Hammertoe Surgery: How to Recover Quickly

  • postop hammertoe surgery recovery

 
 

Hammertoe Correction: What to Expect After Surgery

Hammertoe can only be treated with extra padding or special shoes for so long.

Eventually, many people with curled toes consider hammertoe surgery for permanent pain relief.

Nobody wants to have surgery. But it’s often the best way to get back to wearing your favorite shoes and living your life.

If you’re considering hammertoe surgery, you’re not alone.

Here’s a quick guide to recovery and what to expect after the operation:

How Long Does Recovery Take?

The length of your recovery is dependent on the type of procedure you have and your personal circumstances.

You may start feeling better after a few days. Full healing may take between 2 and 6 weeks.

How Can I Aid Recovery?

You can’t speed up the recovery process. But you can make it easier.

Swelling is common after surgery. 

Try the RICE method to combat inflammation.

RICE stands for rest, ice, compression and elevation.

You’ll also have a bandage on your foot as well as stitches. Avoid getting the bandage wet and do your best to keep it clean.

Finally, you may be given a prescription for pain medication. If not, you can take acetaminophen, ibuprofen or naproxen.

Be sure to take these as directed – NEVER take a higher dosage than recommended by the manufacturer.

Will I Be Able to Walk?

It’s also helpful to limit the movement you need to do. Get up and walk around. Go to the bathroom. But don’t go too far until 2 to 3 days after your surgery.

Get up and walk around. Go to the bathroom. But don’t go too far until 2 to 3 days after your surgery.

Generally, you shouldn’t put weight on your foot for a few days. And only do so if it doesn’t cause pain.

In some cases, you’ll be given crutches or a cane to help you get around for a few days up to a few weeks. The length of time depends on the surgery you have, the number of toes operated on, and the healing process.

You’ll also be given a special shoe for the healing foot to increase mobility and support healing.

Are There Complications?

Complications related to hammertoe surgery are similar to other operations. Infection, bleeding, and damage to blood vessels are nerves are all potential complications.

If you are given general anesthesia, you also assume those risks.

Issues related to the specific surgery are rare. But there is a chance your toe will feel unstable because the procedure requires cutting the ligaments.

There is also a slight likelihood the hammertoe will come back.

Finally, if the surgeon fuses the bone in the toe back together, there is a small chance the bone might not heal.

When Should I Call a Doctor After Hammertoe Surgery?

Here are a few good reasons to ring your doctor after surgery:

  • If the wound is bleeding or there’s drainage
  • If the swelling increases after a few days
  • If pain medication isn’t helping
  • If you have a fever

Hammertoe is a painful problem with a straightforward solution. If you’re ready to straighten your toes and live pain-free, contact us today.

5 Natural Treatments for Diabetic Foot Pain

  • man checking diabetic foot pain

Diabetic Foot Pain: 5 Natural Remedies

Foot pain is a reality for many people with diabetes, and results from damages to the peripheral or autonomic nerves. 

Also known as neuropathy, nerve damage is a very common problem among people with diabetes. In fact, research shows that 60 to 70 percent of people with diabetes have some form of neuropathy. 

Some people with nerve damage show no symptoms. Others may have symptoms such as pain, cramps, tingling, or numbness – loss of feelings in the arms, legs, and feet.

If left untreated, neuropathy can worsen over time and lead to complications such as losses in motor function, foot ulcers and debilitating pain which may, in turn, lead to amputation. 

Fortunately, there are several natural ways get relief from diabetic foot pain. 

The 5 natural treatments for diabetic foot pain

Here are the best natural treatments for diabetic foot pain.

1. Manage blood sugar levels

Managing blood glucose level is universally accepted as the best treatment for diabetic neuropathy.

When your blood sugar reaches toxic levels, it leads to neuropathic complications. Therefore, when it comes to managing diabetic neuropathy, controlling the blood sugar levels should take precedence.

Poor blood glucose levels greatly increase the risk for peripheral neuropathy, which is currently the leading cause of non-traumatic amputations.

The best way to manage your blood glucose level is by eating a healthy diet, exercising, and having regular check-ups by your doctor.

2. Warm baths

One of the easiest natural home remedies for diabetic foot pain is a warm bath.

A warm bath is a viable option since hot water increases blood flow to extremities, hence can help improve circulation in the legs and hands. 

Taking a warm bath is also a good way to relax your body, which may make it easier to cope with the pain.

3. Manage Stress

Stress worsens the inflammations and raises the risk for diabetes complications of all kinds. 

Meditating, exercising, spending time doing hobbies and being with family and friends are typical stress relievers to engage in. 

Exercises, in particular, help to improve circulation hence having a good exercise program can help replenish damaged nerves. Doing exercises can also help reduce blood sugar levels as well as increase your tolerance to pain.

4. Follow a healthy diet

What you eat has a direct impact on your blood sugar levels, so a good diet should be your starting point if you want to manage diabetic complications. 

Doctors recommend you focus your diet on unprocessed foods and reduce consumption of sugary drinks and refined carbs to keep your blood sugar level in check.

Your diabetic diet plan should include food rich in fiber, high in nutrients, and low in sugar content. Vitamin B family like B-1, B-6, B-12 are important for nerves health.

Eating a healthy diet ensures you are getting enough vitamin Bs to boost your nerves health.

5. Quit smoking

Cigarette smoking can influence blood circulation, increasing the risk of foot health problems and other related neuropathic complications. 

Therefore, people with neuropathy should stop smoking at all cost. If you are a smoker and have diabetes, you are at a greater risk of developing nerve damage than diabetic nonsmokers. 

Conclusion

Just like diabetes, there is no known cure for neuropathy, only ways to control and stop its progression. 

However, with these natural remedies, foot pain will be a thing of the past.

For more information on how to get relief from diabetic foot pain and other neuropathic complications, contact us. We specialize in treating diabetic patients and collective surgeries of the foot and ankle.