Foot and ankle surgeons diagnose, treat and help people manage disorders of the foot and ankle.
They can provide comprehensive medical and surgical care for a broad spectrum of foot and ankle conditions and injuries that affect people of all ages.
Foot and ankle surgeons are uniquely qualified to detect the early stages of diseases that exhibit warning signs in the lower extremities: diabetes, arthritis and cardiovascular disease.
Tony Distefano, SMG foot and ankle surgeon, discusses how foot and ankle surgeons help manage these conditions and others which may pose an ongoing threat to a patient’s overall health.
Selected Podcast
What is a Foot and Ankle Surgeon?
Featured Speaker:
Tony DiStefano, MS, DPM FACFAS
Tony DiStefano, MS, DPM, FACFAS, specializes in reconstructive foot and ankle surgery and treatment for sports-related injuries. A fellow of the American College of Foot and Ankle Surgeons, Dr. DiStefano is a member of the American Podiatric Medical Association and New Jersey Podiatric Medical Society. He has been a volunteer reconstructive foot surgeon for Healing the Children, a medical mission in Guatemala. He also has been a volunteer member of the podiatry support teams for the Boston Marathon, Marine Corps Marathon in Washington, DC, and Philadelphia Distance Run. Transcription:
What is a Foot and Ankle Surgeon?
Melanie Cole (Host): Foot and ankle surgeons diagnose, treat, and help people manage disorders of the foot and ankle. They can provide comprehensive medical and surgical care for a broad spectrum of foot and ankle conditions and injuries that affect people of all ages. My guest today is Dr. Tony DiStefano. He specializes in reconstructive foot and ankle surgery and treatment for sports-related injuries. Welcome to the show, Dr. DiStefano. Tell us, what are the most common injuries and/or conditions that you see people suffering with their feet and ankles?
Dr. Tony DiStefano (Guest): On a daily basis, we do see a lot of foot deformities that affect the lower extremity. One of the most common ones tend to be bunion deformities and hammertoe deformities, also flatfoot deformities at the same time. A lot of these deformities are related to genetics. A lot of them are related to activities, being on their feet all day long, and a lot of times which are aggravated by shoes which tend to precipitate and make things worse. Patients come to my office relating a lot of pain, swelling, and discomfort. We have to find ways to reduce that swelling, pain, and discomfort. A lot of times, after exhausting conservative measures, sometimes patients fail to get better and we offer them surgical intervention. A lot of these forefoot deformities tend to be managed surgically because once you remove the bone malalignment and you put that alignment back into position, the pain and the swelling goes away and it no longer hurts with activities and shoes. There are bunion deformities that we repair, hammertoe contractures that we repair, flatfoot deformities that we repair that need surgical intervention.
Melanie: People that have arch problems, pain in the arch or pain from their bunions, what’s the first line of defense? Do you start with what shoes that they wear because that’s our base of support? Do you look at orthotics? Does everyone need a prescription orthotic, or can you go and get Spenco or Superfeet or one of those and solve some of these problems before they get worse?
Dr. DiStefano: Definitely from a conservative standpoint, we talk to them about shoe gear adjustments. In a lot of patients, I would probably say 50 percent of patients’ foot problems are probably because of not wearing appropriate shoes or shoes that are not giving them adequate support. A lot of times we’ll recommend a custom-mold or orthotic that gives them that arch support that prevents that hyperpronation, the collapse of the arch. Because it’s a devastating force that if you don’t neutralize it in shoes and activities, it tends to lead to a lot of the forefoot deformities that we talked about earlier. Definitely from a conservative standpoint, we’ll talk to them about shoe gear adjustments. We’ll talk to them about putting an insole, either an over-the-counter like a Spenco, or more of a custom-mold or orthotic that provides more long-term rigid support and stability.
Melanie: What about other painful conditions such as plantar fasciitis? Because, Dr. DiStefano, so many people suffer from this. They hobble around in the morning. They’re not sure what to do about this. Tell us a little bit about plantar fasciitis and what you do for them.
Dr. DiStefano: I probably see about four to six cases of plantar fasciitis per day, and a lot of it is related to, like I mentioned earlier, inappropriate shoes. The other part of that equation is as a society, we don’t stretch enough. Stretching definitely has to be incorporated into the treatment regimen. We go over stretching regimens with the patients, exercises to be done on daily basis. We’ll talk to them about orthotic management because an orthotic to support that arch will reduce that inflammatory process of the ligament, which is the cause of the plantar fasciitis. A lot of times, we’ll talk to them about definitely modifying their shoe gear because shoes, sandals, flip flop sandals that provide no support, it’s an aggravating factor. So, modifying the shoes, stretching, orthotic management tends to help. Sometimes a round of physical therapy tends to be beneficial. Sometimes when that inflammation doesn’t get better, we’ll talk to them about a cortisone injection. And cortisone is a way to not treat long-term plantar fasciitis, but as a way to bring down some of that inflammation down to a more manageable level so that long term we can make the inflammation go away and hopefully make the pain go away.
Melanie: Tell us about arthritis of the foot and ankle. Is this a common condition? Sounds painful to me.
Dr. DiStefano: It’s definitely, as arthritis is a long-term non-inflammatory process where there’s degenerative joint disease changes that occur at any joints in the lower extremity in the foot. You see it in the ankle joint, the midtarsal joint, the subtalar joint, and the metatarsophalangeal joint, the great toe joint. It’s the wear and tear which tends to be aggravated, again, by shoes and activities. The patient will come in with painful, red, swollen joints, and a lot of times, we’ll give them a cortisone injection to calm it down. A lot of times, this arthritis is exacerbated by foot deformities, the bunion, the hammertoes which put undue stress on the joint and creates more inflammation, more pain. If patients don’t respond to conservative measures, a lot of time we’ll address them surgically by aligning the joint with a bunion surgery, by aligning the joint by hammertoe surgery. Once you realign the joints and put them back into anatomical alignment, the pain, the swelling, the inflammation goes away.
Melanie: Dr. DiStefano, if somebody has got issues with arthritis or bunions or plantar fasciitis or any of these foot and ankle issues, their gait can be thrown off, and it can just head right up the body to their knees, their hips, their back, and cause so many problems. Give a little bit of the importance of taking care of your feet and your ankles so that the rest of your body isn’t thrown off whack.
Dr. DiStefano: A lot of times, we call this compensatory pain. A lot of the patients will come to our office relating knee pain, back pain, hip pain. And once we do a biomechanical evaluation, we’ll notice that a lot of their malalignment is coming from the feet. Aligning that lower extremity so that the foot and ankle is well aligned with the knee and the hip will take a lot of the stress over the rest of the body because when one joint hurts, the rest of the body pays the price, and the body starts to walk differently and aggravate different anatomical structures. Overall, a biomechanical alignment is a good long-term recommendation. And here again, orthotic management plays a huge role. These patients will come in with severe flatfoot deformities, and if you don’t manage the flatfoot from a conservative standpoint and talk to them about shoe gear adjustments, orthotic management, that compensation tends to radiate up into the knee, the hips, and the backs. If you can put that foot back into better anatomical alignment with a brace, with an orthotic, you’ve helped that patient tremendously, because now that pain, that radiating force is no longer radiating up into the knees, into the hips and the back, and it tends to help them out.
Melanie: Now, Dr. DiStefano, these are all chronic conditions that we’ve been talking about, but what about something that’s acute that just happens, an ankle sprain, or a tendon injury, or even overuse injuries? Do you like people to wrap their ankles? Do you like ice? What if someone suffers an injury of the ankle or the foot?
Dr. DiStefano: Anytime, there’s a lower extremity acute inflammation from a sprain, a sudden motion where the foot is put in an undue position with undue pressure, it creates a lot of swelling and inflammation, and that’s the body’s response to the straining that occurred at the anatomical site. Controlling that inflammation at that site of injury is important. Icing, elevating, anti-inflammatories like Advil, ibuprofen is important. What works the best is immobilization of that area. A lot of times, we see a lot of ankle spraining injury, foot-spraining injuries. They come in with a swollen foot, and what works the best is to put them in a soft cast for a week or two just to control that swelling, to control that inflammation. Bring down that inflammatory process that is occurring that is creating the pain. At the same time, the soft cast or CAM walker immobilization tends to control the foot in a more controlled environment so you don’t keep reinjuring it with your day-to-day walking and day-to-day activities.
Melanie: Give us your best advice in the last few minutes here in keeping healthy feet, healthy ankles—shoe wear, footwear, and really taking care of that base of support—and why people should come to Summit Medical Group for their foot and ankle care.
Dr. DiStefano: Basically, a lot of foot problems are related to shoe gear. Shoes that are inappropriate that don’t provide enough support will put a lot of undue stress on the lower extremity, and the worst-case scenario is if you wear a wrong pair of shoe for the wrong pair of activity, then all of a sudden now this is multiplied times a hundred. A patient will come in with a swollen foot for no reason. They didn’t sprain it. They didn’t fall, but it hurts. This is when you wear shoes that don’t give you the maximum amount of support. It puts a lot of stress on the foot and ankle, which creates the pain, the discomfort. When you come to Summit Medical Group, a foot and ankle doctor will evaluate, take care of you, and make sure that your alignment is back into position, talk to you about shoes, talk to you about orthotic management, and help you control the inflammation that’s occurring in an environment that allows you to basically put you back on your feet and be pain-free.
Melanie: Thank you so much for such great information. You are listening to Summit Medical Group Radio, SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
What is a Foot and Ankle Surgeon?
Melanie Cole (Host): Foot and ankle surgeons diagnose, treat, and help people manage disorders of the foot and ankle. They can provide comprehensive medical and surgical care for a broad spectrum of foot and ankle conditions and injuries that affect people of all ages. My guest today is Dr. Tony DiStefano. He specializes in reconstructive foot and ankle surgery and treatment for sports-related injuries. Welcome to the show, Dr. DiStefano. Tell us, what are the most common injuries and/or conditions that you see people suffering with their feet and ankles?
Dr. Tony DiStefano (Guest): On a daily basis, we do see a lot of foot deformities that affect the lower extremity. One of the most common ones tend to be bunion deformities and hammertoe deformities, also flatfoot deformities at the same time. A lot of these deformities are related to genetics. A lot of them are related to activities, being on their feet all day long, and a lot of times which are aggravated by shoes which tend to precipitate and make things worse. Patients come to my office relating a lot of pain, swelling, and discomfort. We have to find ways to reduce that swelling, pain, and discomfort. A lot of times, after exhausting conservative measures, sometimes patients fail to get better and we offer them surgical intervention. A lot of these forefoot deformities tend to be managed surgically because once you remove the bone malalignment and you put that alignment back into position, the pain and the swelling goes away and it no longer hurts with activities and shoes. There are bunion deformities that we repair, hammertoe contractures that we repair, flatfoot deformities that we repair that need surgical intervention.
Melanie: People that have arch problems, pain in the arch or pain from their bunions, what’s the first line of defense? Do you start with what shoes that they wear because that’s our base of support? Do you look at orthotics? Does everyone need a prescription orthotic, or can you go and get Spenco or Superfeet or one of those and solve some of these problems before they get worse?
Dr. DiStefano: Definitely from a conservative standpoint, we talk to them about shoe gear adjustments. In a lot of patients, I would probably say 50 percent of patients’ foot problems are probably because of not wearing appropriate shoes or shoes that are not giving them adequate support. A lot of times we’ll recommend a custom-mold or orthotic that gives them that arch support that prevents that hyperpronation, the collapse of the arch. Because it’s a devastating force that if you don’t neutralize it in shoes and activities, it tends to lead to a lot of the forefoot deformities that we talked about earlier. Definitely from a conservative standpoint, we’ll talk to them about shoe gear adjustments. We’ll talk to them about putting an insole, either an over-the-counter like a Spenco, or more of a custom-mold or orthotic that provides more long-term rigid support and stability.
Melanie: What about other painful conditions such as plantar fasciitis? Because, Dr. DiStefano, so many people suffer from this. They hobble around in the morning. They’re not sure what to do about this. Tell us a little bit about plantar fasciitis and what you do for them.
Dr. DiStefano: I probably see about four to six cases of plantar fasciitis per day, and a lot of it is related to, like I mentioned earlier, inappropriate shoes. The other part of that equation is as a society, we don’t stretch enough. Stretching definitely has to be incorporated into the treatment regimen. We go over stretching regimens with the patients, exercises to be done on daily basis. We’ll talk to them about orthotic management because an orthotic to support that arch will reduce that inflammatory process of the ligament, which is the cause of the plantar fasciitis. A lot of times, we’ll talk to them about definitely modifying their shoe gear because shoes, sandals, flip flop sandals that provide no support, it’s an aggravating factor. So, modifying the shoes, stretching, orthotic management tends to help. Sometimes a round of physical therapy tends to be beneficial. Sometimes when that inflammation doesn’t get better, we’ll talk to them about a cortisone injection. And cortisone is a way to not treat long-term plantar fasciitis, but as a way to bring down some of that inflammation down to a more manageable level so that long term we can make the inflammation go away and hopefully make the pain go away.
Melanie: Tell us about arthritis of the foot and ankle. Is this a common condition? Sounds painful to me.
Dr. DiStefano: It’s definitely, as arthritis is a long-term non-inflammatory process where there’s degenerative joint disease changes that occur at any joints in the lower extremity in the foot. You see it in the ankle joint, the midtarsal joint, the subtalar joint, and the metatarsophalangeal joint, the great toe joint. It’s the wear and tear which tends to be aggravated, again, by shoes and activities. The patient will come in with painful, red, swollen joints, and a lot of times, we’ll give them a cortisone injection to calm it down. A lot of times, this arthritis is exacerbated by foot deformities, the bunion, the hammertoes which put undue stress on the joint and creates more inflammation, more pain. If patients don’t respond to conservative measures, a lot of time we’ll address them surgically by aligning the joint with a bunion surgery, by aligning the joint by hammertoe surgery. Once you realign the joints and put them back into anatomical alignment, the pain, the swelling, the inflammation goes away.
Melanie: Dr. DiStefano, if somebody has got issues with arthritis or bunions or plantar fasciitis or any of these foot and ankle issues, their gait can be thrown off, and it can just head right up the body to their knees, their hips, their back, and cause so many problems. Give a little bit of the importance of taking care of your feet and your ankles so that the rest of your body isn’t thrown off whack.
Dr. DiStefano: A lot of times, we call this compensatory pain. A lot of the patients will come to our office relating knee pain, back pain, hip pain. And once we do a biomechanical evaluation, we’ll notice that a lot of their malalignment is coming from the feet. Aligning that lower extremity so that the foot and ankle is well aligned with the knee and the hip will take a lot of the stress over the rest of the body because when one joint hurts, the rest of the body pays the price, and the body starts to walk differently and aggravate different anatomical structures. Overall, a biomechanical alignment is a good long-term recommendation. And here again, orthotic management plays a huge role. These patients will come in with severe flatfoot deformities, and if you don’t manage the flatfoot from a conservative standpoint and talk to them about shoe gear adjustments, orthotic management, that compensation tends to radiate up into the knee, the hips, and the backs. If you can put that foot back into better anatomical alignment with a brace, with an orthotic, you’ve helped that patient tremendously, because now that pain, that radiating force is no longer radiating up into the knees, into the hips and the back, and it tends to help them out.
Melanie: Now, Dr. DiStefano, these are all chronic conditions that we’ve been talking about, but what about something that’s acute that just happens, an ankle sprain, or a tendon injury, or even overuse injuries? Do you like people to wrap their ankles? Do you like ice? What if someone suffers an injury of the ankle or the foot?
Dr. DiStefano: Anytime, there’s a lower extremity acute inflammation from a sprain, a sudden motion where the foot is put in an undue position with undue pressure, it creates a lot of swelling and inflammation, and that’s the body’s response to the straining that occurred at the anatomical site. Controlling that inflammation at that site of injury is important. Icing, elevating, anti-inflammatories like Advil, ibuprofen is important. What works the best is immobilization of that area. A lot of times, we see a lot of ankle spraining injury, foot-spraining injuries. They come in with a swollen foot, and what works the best is to put them in a soft cast for a week or two just to control that swelling, to control that inflammation. Bring down that inflammatory process that is occurring that is creating the pain. At the same time, the soft cast or CAM walker immobilization tends to control the foot in a more controlled environment so you don’t keep reinjuring it with your day-to-day walking and day-to-day activities.
Melanie: Give us your best advice in the last few minutes here in keeping healthy feet, healthy ankles—shoe wear, footwear, and really taking care of that base of support—and why people should come to Summit Medical Group for their foot and ankle care.
Dr. DiStefano: Basically, a lot of foot problems are related to shoe gear. Shoes that are inappropriate that don’t provide enough support will put a lot of undue stress on the lower extremity, and the worst-case scenario is if you wear a wrong pair of shoe for the wrong pair of activity, then all of a sudden now this is multiplied times a hundred. A patient will come in with a swollen foot for no reason. They didn’t sprain it. They didn’t fall, but it hurts. This is when you wear shoes that don’t give you the maximum amount of support. It puts a lot of stress on the foot and ankle, which creates the pain, the discomfort. When you come to Summit Medical Group, a foot and ankle doctor will evaluate, take care of you, and make sure that your alignment is back into position, talk to you about shoes, talk to you about orthotic management, and help you control the inflammation that’s occurring in an environment that allows you to basically put you back on your feet and be pain-free.
Melanie: Thank you so much for such great information. You are listening to Summit Medical Group Radio, SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.