Joey Wahler (Host): This is Health Matters: Insights from WCH Medical experts. Thanks so much for joining us. I'm Joey Wahler. Our guest is Dr. Kyle McCray Smith. He's a podiatric surgeon. Doc, welcome.

Kyle McKray Smith, DPM: Thanks, Joey. Happy to be here.

Host: Thank you. Glad to have you aboard. So first, what would you say most of all first drew you to healthcare and to specialize in foot and ankle surgery specifically?

Kyle McKray Smith, DPM: Sure. Yeah. I guess, the genuine story of that is I was in undergrad for physical therapy. And I was working with a research professor and she got to know me pretty well over a few years. And she's like, you know, "I really think you'd thrive in a more surgical specialty" than what I was, I guess, going into.

So through her guidance, I actually looked into a few surgical specialties, cardiothoracic hand and wrist, ortho, and then podiatry. So, foot and ankle surgery. And I shadowed all three of them. And I got lucky enough to be with a few podiatric surgeons and really took off from there. So, that's kind of how it came to be in a nutshell. But I've always had an interest in working with my hands, and it was a very appealing field to kind of see like a true specialist at work. So, the rest is history. Once I shadowed a few and had a good experience, that's where it all started.

Host: That's great. And so, you're working with your hands to help heal people's feet. And what would you say, more than anything, Doc, makes that area of the body so uniquely complex?

Kyle McKray Smith, DPM: Loaded question. So, I'd say it's the combination thing. I mean, the foot and ankle is really a system of not just bones, or not just tendons or ligaments. But there's nerves and there's skin surfaces to consider, you know, all kinds of things. You don't want things to break down on you, and you really have to understand the full system of the foot and ankle to make it work.

And on top of that, you know, foot and ankle is just from a surgical perspective maybe one of the least forgiving fields in medicine, just in the sense that you operate on the foot or ankle and you ask that person to stay off of it for four weeks or six weeks or eight weeks. And that's very tough to do. You operate on someone's wrist or someone's shoulder, they don't have to be on it. It's not in a gravity-dependent position. So, the foot and ankle is just a place you have to have a full comprehensive understanding of really all the systems involved to get good outcomes and have happy patients.

Host: And I would imagine like many things in life, you find that people take their feet for granted until they become an issue, right?

Kyle McKray Smith, DPM: Exactly. Yeah. Yeah. It's one of those things that you don't think about it, you take steps every day. And that is another thing. I mean, part of what attracted me to the field too, to your first question, is the idea of keeping people moving, keeping them mobile, keeping them doing the activity they love.

And that goes both ways. So when you have to undergo surgery, then you have to learn to alter the way you walk or not walk at all. And very tough because you realize how much you use your feet at that point.

Host: Yeah, no question about that. So, you are board-certified in foot and ankle reconstruction, both. So in a nutshell, what would you say that means for patients in the community?

Kyle McKray Smith, DPM: So in a nutshell, that maybe means more advanced care than most people may recognize. It can provide some tertiary care. So, it includes joint replacements and complex trauma, limb salvage, revision surgery. It just means you're getting a comprehensive specialist of the lower extremities. So, understanding the full breadth of what the extremity is and more advanced surgical technique.

Host: Now, as you well know, people sometimes tend to have more foot issues, ankle pain as they get older. But what are some examples where a simple ache can actually be a sign of something deeper than just age?

Kyle McKray Smith, DPM: Sure. And so, I think there's times where there's something else going on. Like for example, you may have some joint instability. So for the ankle joint, let's say, there's been several sprains and you think it's just hurting because of the sprains. But in reality, there's instability of that joint may need stabilized. And furthermore, if you let that go too long, the complication of that may be early arthritis of the joint or rapid arthritis of the joint. So, It may come off as an ache after a sprain, but it's more of an unstable joint that needs to be addressed.

Host: At what point should someone typically stop trying home remedies and see a specialist like yourself?

Kyle McKray Smith, DPM: Yeah. So, I'll answer that to some degree. I answer that question for my patients quite a bit. And I think the key is when it's no longer manageable. So if you're trying to do some things, you're doing the basic things you can read about online, the ice, the rest, the better shoes maybe, and it's still nagging you, you can't achieve what you want to achieve. That's when it's usually time to go see someone.

And there are other findings that should be taken more seriously, like when you have true swelling of the area. So, swelling or effusion usually means something's actively happening there. Another classic one is night pain. So if there's night pain associated with it, there's usually something more going on. And your body's more sensitive to pain actually at night. So if you're having it while you sleep, it's something to get looked at sooner than later.

Host: I'm glad you mentioned shoes. Footwear is something I wanted to ask you about. How often do you find in your experience that the wrong footwear can cause an issue for someone, or at the very least, possibly not protect them enough against preventing an issue?

Kyle McKray Smith, DPM: Great question. I think sometimes a good shoe or a good orthotic, a good insert, could avoid a lot of surgeries some patients. I mean, it's a matter of if you just supported the structure better, because we may all have some degree of minor arthritis or small tendonitides. But whenever you're just kind of barreling through your life in a non-supportive shoe, all that stress, every step you take is going through your structures instead of the shoe.

And I will say more people are getting better at wearing supportive shoes. The word's kind of gotten out on your common brands like Nike. And Nike even knows, they're actually coming out with some more supportive shoes. But orthopedic-based shoes are better. So your Brooks, your Hokas, your Saucony, your good running shoes, New Balance, things of that nature will just provide better support.

Host: And not to criticize by any means, those that work in shoe or sneaker stores. But if you think about it, those people typically aren't really qualified enough probably to give all that much information about what kind of support someone needs if they are prone to a foot or ankle issue, right?

Kyle McKray Smith, DPM: Yeah, most like especially commercial shoe stores. Now, if you go to specialty running shoe stores, you'll find qualified individuals. And some of them even carry pedorthist, which are shoe specialists, via places like Fleet Feet—it's little bit of a tongue twister, but Fleet Feet—and they have location, I think up on Central that's more Toledo-based. There's Second Sole in Perrysburg would be the closest thing to Bowling Green where it's a dedicated running shoe store, not just like, I guess, your run-of-the-mill shoe store.

Host: Now, I want to ask you about one of your philosophies. I know you've said that an accurate diagnosis you believe is more than just naming or IDing a condition. So, tell us what you mean by that.

Kyle McKray Smith, DPM: So, I think a lot of times, as part of, I guess, my field is being almost like a subspecialty surgeon. And there's a lot of diagnoses that get a label, but never get a cause or an understanding as to why. So, there's several things you could look at, but maybe someone's got bad Achilles tendonitis or peroneal tendonitis. And a lot of times that's all that gets focused on is that tendon disorder or that tendonitis, and there may be things missed such as an underlying cavus foot, which is a high-arch foot. So, someone with a high arch tends to place more stress on those structures. And a lot of times that may be need to be addressed in conjunction with the tendonitis, because when you focus on just the tendonitis, you may get either recurrence or incomplete resolution. So, I think the accurate diagnosis is understanding why it's there in short.

Host: And so, you want to give a patient the full picture when there's a diagnosis.

Kyle McKray Smith, DPM: Right. Correct. Yeah.

Host: So, what would you say are the most common treatments these days for foot or ankle pain? How about first the non-surgical approach?

Kyle McKray Smith, DPM: So, non-surgical, I always think about it, regardless of what it is or what it may be, just generically speaking, try to understand what you have and build a small arsenal around it. So as the patient, you're kind of responsible for your care more than I am to some degree after we spend 10, 15 minutes together.

So if you have a condition that you're trying to manage non-surgically, you know, experiment with shoes and orthotics and occasional braces. And make sure you have some anti-inflammatories on board, medication-wise, whether that's over-the-counter or something prescription grade. Injections are still fairly common.

I will say regenerative medicines becoming more popular and platelet-rich plasma or PRP injections, things of that nature. Steroid injections are still like a standard and a mainstay. But we are finding some better results conservatively with more advanced biologic injections.

Host: And what are the most common surgical procedures that are available here?

Kyle McKray Smith, DPM: Well, that's the fun of being the board-certified foot and ankle surgeon. It's quite an array of procedures, just a lot of structures in the foot and ankle. One specific one or maybe we can talk about a few, but I guess total joint replacement's becoming more and more popular in the ankle. And up until let's say 10 to 15 years ago, we didn't have great technology for ankle replacements and we're still in an era where our era of surgeons is kind of defining what those standards will look like and the longevity of the implants will look like. But there's certainly been a big advancement in ankle replacements.

And, I would say, minimally invasive surgery. So minimally invasive surgery, we're in a time where instruments and engineering is far more advanced than it was 20 or 30 years ago. So, we're able to achieve a lot of the same procedures. We could then, but through much smaller incisions and then allow for a quicker recovery.

Host: It's interesting to hear you mention ankle replacement, because I've interviewed doctors that do the very common other replacement surgeries, knee, hip, shoulder. How about the ankle? How much of a difference can that make in someone's quality of life when you replace an ankle?

Kyle McKray Smith, DPM: Yeah, a big difference. I mean, you're usually deciding between, at that point, ankle fusion or ankle replacement. Ankle fusion is still a great procedure. It's tried and true. It's got great outcomes. But I will say just from experience, the ankle replacement patients seem to be happier. They maintain a little bit more mobility and a little bit more function, or at least not have as much of a functional deficit, I should say. But ankle replacement, with it being a newer technology, it's not for everyone. So, the ankle fusion sometimes is still the safer procedure. But the right patient with the right indications, the ankle replacement, that can provide better outcome in my opinion.

Host: Couple of other things for you, doc. How about the fact that I would imagine, fortunately, you have many great success stories in your experience, but how about one off the top of your head where a patient's outcome really changed dramatically once the root cause of their pain was identified and addressed?

Kyle McKray Smith, DPM: Sure, sure. Yeah. So, I guess one thing we didn't touch much on is peripheral nerve work or revision surgery. So, I do enjoy that line of work quite a bit. It's very rewarding. And I'd say there was a patient that had a fifth metatarsal fracture. Unfortunately, kind of went through a course of surgeries, where they had the fracture fixed. It failed to heal So, it was refixed, and they still had pain. So then, the hardware was removed, and they still had pain. And that's where we identified that they had actually had a nerve injury probably at the time of the first procedure. And when we were able to repair the nerve, the pain finally resolved.

Host: And you mentioned how rewarding that is. What's that like for you at the end of a workday when you know that you've been able to make that kind of a difference in someone's life? Just in terms of getting around and being able to get back to doing what they need and/or love to do? What's that like for you?

Kyle McKray Smith, DPM: Man, that's what it's all about. Everything we do, I mean, all the battles we fight or all the training we go through, and all you need is that one patient, it could make up for kind of a stressful or hectic day otherwise. So, it's a great feeling. It's very rewarding.

Joey (Host): That's awesome to hear. And so in summary here, what would you say is the most important point you'd like to get across to those joining us and really, in fact, to everyone in the community that you want them to understand about foot and ankle pain in view of what you do. If there's one thing you want people out there to know, what is it?

Kyle McKray Smith, DPM: It's a big question. I would say. If you're having pain, you don't have to live in pain. I mean, it's one of those things, there's almost always a treatment, there's almost always an option. And there are some patients that may feel like there's nothing that they can have done or they've been told perhaps there's nothing that can be done. But I wouldn't be shy about reaching out and seeing a specialist.

Host: Yeah, because I'm sure you find that there are in fact people, for whatever reason, that procrastinate that.

Make the situation worse than it needs to be. But you're here to say that that doesn't need to happen, obviously, right?

Kyle McKray Smith, DPM: Correct. Yeah.

Host: Well, folks, we trust you are now more familiar with foot and ankle pain and their treatment. Doc, keep up all the great work. And I don't know how you keep all those little bones in the foot and ankle straight. But clearly, you're doing a great job of it and the community is thankful for that. Thanks so much again.

Kyle McKray Smith, DPM: Yeah. Thank you for having me. I appreciate it

Host: Absolutely. And to learn more about what may be causing your foot or ankle pain, we ask that you please call Falcon Sports Medicine and Orthopedics at 419-372-2271 and use option two.

If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks so much again for being part of Health Matters: Insights from WCH Medical experts.