Joey Wahler (Host): It can literally help you stand better on your own two feet. So we're discussing reconstructive foot and ankle surgery. Our guest, Dr. Charles Penvose. He's a Podiatrist specializing in foot and ankle surgery with Memorial Health System, Ohio. This is Memorial Health Radio, a podcast from Memorial Health System, Ohio.

Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Penvose. Thanks for being with us.

Charles Penvose, MD: Hi, Joey. Thanks for the invite.

Host: Absolutely. Appreciate you hopping aboard. So first, this may sound odd, but I was thinking about this, preparing to speak to you. Do you think most people realize that technically the ankle is part of their foot?

Charles Penvose, MD: I think that oftentimes when people hear the term podiatrist, they think of foot and they don't often think of the ankle, but, there are quite a few of us who specialize in rear foot ankle surgery, even total ankle replacement, such as myself. So, I would hope they do at least when they think of coming to my office and something I can help them with. I think a lot of podiatrists these days do foot and ankle.

Host: Gotcha. How often would you say from your experience, foot or ankle surgery is needed because of wear and tear, age, et cetera, versus an injury or some other condition?

Charles Penvose, MD: We see a wide variety of pathology with different reasons. You know, anything from congenital deformities that these folks have had since birth, you know, that could be a high arch or a flat foot and even post traumatic type arthritis and then anything from wear tear to the tendons and the bones.

And you can have arthritis and you can have tendonitis. And then there's deformities of the toes, hammer toes, bunions. So we see a wide variety of these different types of pathologies. So I would say, it's just a complete mixture and it makes for a nice day.

Host: I'm sure. So what are some common reasons someone would need, let's start first, please, with foot surgery and what procedures are typically done for those?

Charles Penvose, MD: Typically, you know, after we exhaust all conservative care, which is typically, you know, shoe gear modifications, paddings, different bracing, if we have to move on to surgery, I would say the most common, would be like a first, metatarsal phalangeal joint, which is your big toe joint fusion. So this is a fusion that is done across that joint in order to prevent motion and decrease pain.

There's also hammer toe surgery, which can be done now minimally invasively, which is something I take pride in offering to patients in my area. And this is done with burrs and it allows for a smaller incision and allows people to get on their feet quicker. And then there's, you know, obviously hammer toe surgery and there's a wide variety of different ways to do this, which, you know, anything from very open with pins to implants to more minimally invasive approaches

Host: To backtrack for a moment, a toe fusion, that would be to address what?

Charles Penvose, MD: Usually a painful contracture of the toe. So if the toe is bent, an individual's having some type of irritation on the top of the toe, pain, maybe a pre ulcerative lesion. And in order to straighten that out and allow them to either wear shoes or try to reduce their pain.

Host: Now, I was actually going to ask you this anyway, because I've experienced it myself, but you led me beautifully into it right here, so this is a good time. When you say a bent toe, so I have one toe in the middle of my foot, I actually forget which one it is, and I have socks on right now, so I can't even look, but in any event, I have one of those toes, where the top half of it is a little bit curled in toward the one next to it.

If I never saw it. I wouldn't know. I don't feel any pain. I don't feel, feel like it's any different. What is that from? And is that something that should be addressed over time or not necessarily?

Charles Penvose, MD: Yeah, good question. So it's from an imbalance of tendons. There's a lot of different theories, actually, what causes bunions and hammer toes, and there's different theories. There's no exact explanation for those, but it's thought to be a irregularity, at least in the muscle pull for the surrounding muscles, and it causes almost a retro buckling of the joint, and it can cause joints in the toes and the ,the joint behind the toes that can contract.

And over time, those can get painful in some folks, but if it's not painful, there's really nothing you have to do for it. The only time really these, these folks are having surgery is if it's painful every day and it's affecting their daily life considerably.

Host: Okay. Good to know. We hear a lot about plantar fasciitis and how painful it can be. What exactly is that and how is that addressed if it needs to be?

Charles Penvose, MD: Yeah, so this is probably one of the most common things we see as podiatrists, foot and ankle surgeons in the office, and essentially you have a ligament on the bottom of your foot called your, your plantar fascia, and it attaches, from the all the way from the bottom of the toe joints, all the way to the heel.

And oftentimes people can get tightness in this fascia and oftentimes they have tightness in their Achilles tendon as well. And over time, they can build up inflammation in the heel and that can cause them a great deal of pain. And one of the most common textbook signs is when you get out of bed and you just, you go to put your feet down and you're in a lot of pain, these folks typically come into the office and, and they're in, they're in pretty excruciating pain.

So there's a variety of different treatments, but 90 to 95 percent of these people can get away with conservative care and not need surgery.

Host: Interesting. Okay. I did not realize that because as I'm sure you well know and much of our audience probably as well basketball players tend to get plantar fasciitis perhaps at a more prevalent rate than the average population, you would know better than I obviously, but especially it seems bigger people like big men in basketball, guys that are, you know, 6'8, 6'10, 7 foot, right? Because of what, putting more weight on the foot?

Charles Penvose, MD: Yeah, these are, I mean, these are, tend to be heavier individuals and they have a lot of wear and tear. I mean, if you consider how many basketball games there are compared to like football games, as it being, you know, considered a no con or less contact type sport, I think that's a lot of why they tend to, uh, see that also there, there seems to be a prevalence of like flat feet, among like basketball players, at least I've seen in, in my experience.

And so that could contribute as well, but I think the majority of it is, is the weight.

Host: Gotcha, the weight, and as you point out, combined with the fact that they're taking all those trips up and down the floor for a two hour, two and a half hour period that covers probably several miles during the course of a game, right?

Charles Penvose, MD: It's impressive. I mean, it's a great, great exercise.

Host: For sure. So switching gears a little bit. Let's talk about the most prevalent causes of ankle surgery and the procedures to address those.

Charles Penvose, MD: Okay, so I would say most common would be like ankle instability, a lot of inversion type sprains. People will go ahead and they will sprain their anterior talofibular ligament. So, this is a ligament on the side of the ankle and often times it, it heals from conservative care, but sometimes we need to go in and actually repair that ligament.

There's also arthroscopy, which is going in and cleaning up early arthritis in the joint. And then, more often we're seeing folks, especially post traumatic ankles, where the indication for ankle replacements is actually becoming more and more prevalent, which is very exciting and more cutting edge.

Host: Interesting because in interviewing various doctors about replacement surgery, it's typically more about knees and hips, but you say ankles are on the rise.

Charles Penvose, MD: Well, I would say that the technology has improved. It's something that's been around since the 70s. However, we're on, I believe, the fourth generation of these types of implants. There's actually technology now that can actually take a CT of a patient and create patient specific instrumentation, which can allow more precision with cutting and placing the implants because the position of the implant is key, especially when you're considering such a small joint.

Host: And what would typically be a reason that someone would need complete ankle replacement?

Charles Penvose, MD: Most of the time, at least traditionally, the indications have been, you know, an older patient who had post traumatic arthritis or some type of arthritis where you have minimal deformity at the ankle and is looking for something other than fusion because both have their pros and cons. But some folks don't want fusions and it, and it offers another, another option for these people.

Host: Okay. A couple of other things, vascular conditions and metabolic issues like diabetes, for instance, those can be reasons for foot surgery too, right?

Charles Penvose, MD: Oh, Absolutely. And I think one of the cool things about podiatry is there's so many different subsets of specialties and there's, there's folks that do, you know, a lot of sports medicine, some just focus solely on limb salvage and diabetes. And a lot of those folks are at higher risk because the diabetes affects the small vessels and the eyes, the kidneys, and also the nerves that innervate the foot, the small blood vessels. So these patients, you know, they become vasculopaths where they're not getting the blood flow to the foot. That opens up for issues when they have neuropathy, they form wounds, these wounds get infected, infection goes to the bone, and then oftentimes they need amputation.

So it's a big part of our job is trying to prevent amputations and trying to keep these folks healthy and keep a close eye on their feet.

Host: Absolutely. And finally, in summary here, Doctor, it sounds like you're very passionate to say the least about what you do. I'm just curious when you were deciding which way to go professionally, what made you decide not just to become a doctor, but to choose podiatry?

Charles Penvose, MD: Shadowing different doctors and I shadowed the podiatrist and it was a great, you know, quality where he was able to help folks and they were able to have almost immediate relief, especially, um, like sports type injuries and in different, uh, musculoskeletal type problems.

And I just, piqued interest, um, as far surgery. And that's why I ended up doing my reconstructive foot and ankle, fellowhip in addition to residency. So I performed that in Columbus and I just fell in love with minimally invasive, um, surgery and different operations and really just treating people, um, like family. You know, not everyone needs surgery. A lot of folks do well with conservative care, but I think there's definitely a need out there. And that's just what I look for when I, when I, uh, go to

Host: Well, that's awesome that you had that experience. In fact, talking with different doctors, it seems many have had a similar experience to yours where early on when they're starting first to study medicine, it's shadowing someone or having the influence on them of a mentor that really points them in the direction of where they want to go, right?

Charles Penvose, MD: Absolutely. And I think that's exactly what happened with me and, you know, still mentors that I talk to to this day, in, you know, Atlanta, Georgia, Columbus, like, and, you know, also my friends and colleagues and everyone, it's really, it's a supportive group there's, roughly 700 or so that graduate per year.

And then if you look at allopathic like MD, there's 30,000 or so that graduated here, so it's a, it's a nice close knit group, a lot of us know each other and it's just, it's very supportive and I think, you know, it's just, it just seems to be evolving and just the education and the training has just gotten superb and I look forward to what's going to happen in the future with the profession.

Host: Well folks, we trust you're now more familiar with foot and ankle reconstructive surgery. Dr. Charles Penvose, a pleasure. Thanks so much again.

Charles Penvose, MD: All right, thank you for having me. I really appreciate it.

Host: Same here. And for more information or to connect with a provider, please do visit mhsystem.org/podiatry. Again, mhsystem.org/podiatry. Please remember to subscribe, rate, and review this podcast and all the other Memorial Health System podcasts. If you found this podcast helpful, please share it on your social media.

Joey Wahler (Host): I'm Joey Wahler, and thanks again for listening to Memorial Health Radio, a podcast from Memorial Health System, Ohio.