Hi, the pain with this procedure is managed well with rest, elevation, icing and most importantly, pain medication when required. Driving starts around week 3.

@@DrOzanAmir thanks for responding.

Thank you, I recall watching the episode where the young lady had the calluses removed under general anaesthesia, followed by skin grafting. I would say most of the very painful IPKs that I have seen, the patients are heavy smokers. Speaking with colleagues, they have also noticed this.

@@DrOzanAmir thank you for your quick reply to my questions, complete with typos. I went back and corrected them. Sometimes, my IPAD keyboard can’t keep up with my typing and autocorrect challenges a number of words on me. I understand Olmstead is very rare and it was fascinating to see the nerves growing into her calluses once they were able to anesthetize her. So far, the skin graft seems to be helping her. Dr. You, a podiatrist in London, doesn’t think they would allow her to do a skin graft in a similar case. I am not sure where you practice, but I would love to know about procedures such as skin grafts that aren’t OK in every country and how countries can vary in handling a variety of conditions by developing their own cutting edge techniques. Do you have a lot of PPK or PC (pachyonychia congenital) patients? I am also curious about how you treat patients with icthyosis or severe plaque psoriasis on their feet. Both conditions seem beyond just urea cream.

@@Familylawgroup I didn't pay any attention to the typos:) I am based in Australia. I have not performed skin grafts for this condition, mainly because I am not aware of the outcomes. I specialise in reconstructive foot surgery and see very few of these skin and nail conditions. When I was a general podiatrist, I use to see them more often especially icthyosis or severe plaque psoriasis. It involves a lot of time and care debriding away the hardened skin and sanding it down. The person would need to come in regularly to have this performed.

Hi, thank you for the nice comment. This was done under general anaesthetic. After 4 weeks you can slowly start increasing activity. If the toe becomes painful or swells, then you will need to rest. It usually takes 12 weeks before you feel comfortable walking long distances.

​@@DrOzanAmiragain, thank you very much doctor. is this operation only done with general anesthesia? I am asking you because I am a little afraid since I have had two general anesthesias when I was little. I had surgery on my eyes and my second one fell so bad I couldn't wake up

@sofaki1431 this procedure can be done easily under local anaesthetic around the foot.

it can be done. thank you very much doctor be well and help the world.❤

it can be done. thank you very much doctor be well and help the world.❤

Hi, Yes patient can bear weight in a post operative shoe with good thick bandaging around the foot. To decrease recurrence, I now always go into the subcutaneous tissue. I was more conservative back when I made this video.

Thanks very much for your early response. I appreciate it. I do have another question please. How do you distinguish clinically for sure between plantar warts(Verruca plantaris) and corns? It would appear the surgical treatments differ a bit. Secondly, in places where phenol is unavailable do you thick diathermy cauterization will do?

@kendaddi5857 most often a verruca and corn are easily distinguishable. In a small percentage a verruca can resemble a corn. A Podiatric surgeon colleague, Dr Ian Reilly, sent off corns which he excised to pathology, and they came back as verruca tissue. Yes, diathermy works well. When it is available, I use diathermy over phenol.

Hi, to be safe, I would advise not doing any intense MMA for a good 12 weeks to allow the soft tissue to scar around the implant. With kicking, grappling and side to side movements, the implant can dislodge from the sinus canal.

@@DrOzanAmir but sir can I do intense mma training after 12 weeks and is there any guarantee that it cannot cause any problem for lifetime and in addition I have also symptomatic accessory navicular bone and my doctor advised me both kidner procedure and subtalar implant surgery at the same time.. And sir thank you very much for your reply.

@aatifkhan10thb48 I wouldn't give a life time guarantee with the implants staying in place or not causing pain while performing MMA. Have a chat with your surgeon on his thoughts. I have my approach to these but other surgeons may have differing experiences with Hypocure.

@@DrOzanAmir I have pain in accessory navicular bone so if I go for only kidner procedure then does only kidner procedure helpful to remove pain.....

@aatifkhan10thb48 Kidner is effective in removing pain as there will no longer be inflammation at the synchondrosis. The hypocure will reduce the amount your foot is pronating. Your surgeon must feel that controlling pronation is also required to reduce your pain. I haven't had the opportunity to asses you, so it would be inappropriate for me to comment if the Kidner procedure is adequate on its own.

Running subcuticular using 3-0 monocryl

Hi, you maybe referring to the Extensor tendon, that sometimes pulls the toe upward. This usually over time relaxes - you can tape the toe down. Just make sure with your surgeon this is the issue before taping.

Yes, they have a reasonably high recurrence rate. To decrease recurrence a wide excision needs to be performed. If you haven't already, try a corticosteroid injection to see if this decreases the size of the plantar fibroma.

@@DrOzanAmir That was the first thing he did twice and it didn’t work, then oral steroids and that didn’t work either so I opted for surgery and that’s when he informed me that it could come back so I canceled it but it’s still an option for me

Would you recommend surgery? Nothing else has helped me since then

@maryjones9925 The only time I recommend this procedure is when all conservative care fails (including going into a boot) and the pain is significantly affecting the person's activity levels.

@@DrOzanAmir I have a boot that I use when the pain is too much to handle and it still doesn’t help that much just dulls it temporarily I ice it down when it swells which is every day because of it pressing on the nerve and being back at work I am already limping again.

No, unfortunately.

With club foot, this technique won't be as effective as lengthening the Achilles tendon to increase dorsiflexion.

Hi, I haven't tried the twist implant. Recently used the PitStop implant which has a couple of unique features. Great to hear all went well with your procedure.

Glad you got benefit.

What dose and type of LA do you use and how long does usuall analgetic effect last?

I usually use a long acting local, either 0.5% bupivacaine or 0.75% ropivacaine. Total volume approx 8-10ml. Effect varies from 2-3 hrs to several hours.

Thank you for your great explanation😊I am going to incorporate this block to my hallux valgus block portfolio:)

It works really well. I use it for all distal metatarsal osteotomies. After the procedure, I perform another mayo block to give further pain relief post-op. This second injection is usually a 50:50 mix of local and saline.

Bleeding can be an issue with excision of plantar warts. Give it a week or so and the pain should settle down.

Very understandable. You really need to plan around it.

If it is just shaving off the bone it isn't too bad. Keep it elevated and iced for a few days. They gave me oxy for the pain, and I only ended up using it for the first two days. After that Tylenol was just fine.

I would have the Doctor check it again, to make sure there is no residual infection.

@@DrOzanAmir he checked it and told me everything is fine but I'm worried as it still has swelling and redness along with pain. Toenail is growing too with good speed. Should I be worried?

@ShaheenCooking-Vlog some pain and swelling can be normal as it is still early days. The Dr would know best. However, if you had the procedure in the video, where the nail was totally removed, you would not be seeing any nail growth 6 days after the procedure.

@@DrOzanAmir my nail was totally removed and it's in my genes that they grow faster

​@@DrOzanAmir I wanna know if swelling and pain is normal on the nail bed after this procedure? It's been 6 days now. My nail grew 1 inches

Hi, you can leave it alone and it may go down on its own. Or if it's increasing in size or starts causing pain, it can be drained.

I would advise waiting also. Even of the surgery has not been able to achieve the desired outcomes, nothing can be done right now. I wouldn't have anyone touch the toe until complete healing has occured. Further trauma (more surgery) could cause other issues.

@DrOzanAmir Hello! My surgeon told me there are 3 options: Hit Physical Therapy aggressively, but no guarantees. Do a syndactlylization (sp?) Or a Tendon stretching/release using a 'Z' cut which is more versatile. He feels this is what's going to give the best/immediate results of getting the toe to lay down and soft tissue realignment. My 5th toe is now starting to ride on top of my 4th toe even more now and causing some discomfort. I'm getting nervous as it's this Friday, Aug 30th. Do you think this could cause other issues by having this done? It'll be my 3rd surgery since last December in this area, but 1st time with the tendon. He wants to put me in a boot right after surgery, heal bearing only at first. He also said I'm a scar former, so I'm concerned that if I'm heal bearing, my toes will naturally want to try and elevate causing that pinky toe to not lay down like it should. I am not a Dr of course, but what are your thoughts on all of this? I'm just so nervous!

Hello. Your surgeons advise is sound. There are always risks with any procedure, but hopefully this time the toe stays down. Its a good idea to go into the boot. If you find the toe wants to elevate with walking on the heel, then you can lower the foot down. Hope all goes well on Friday and that your recovery is uneventful.

@DrOzanAmir Great!! Thank you so much for getting back with me again. I will be certain to go into the boot right away then. I think I'll eliminate having the pain pump so I won't have to wait until any numbing wears off to go into the boot. Your advice has helped me so much and I was so glad I reached out to you in the beginning. You have been a blessing to me!! Thank you for everything! I hope this is it and it works. I will keep you updated.

I would discuss your concerns regarding outcomes and what he suggests in dealing with these issues. The CT won't make any difference. Evaluation of this problem is mainly clinical. Lmk how you go after the consult.

Yes, just read your other post and replied. Hopefully chat soon.

Hi, I know how debilitating this problem can be. I can assess and see if anything further can be done. If you can contact my prac manager Maree, she can help you to make an appointment at reception@podiatricsurgerycentre.com.au If you speak with Maree, please send through to her all your reports, so I can have a read before the appointment.

Thanks Philip, really appreciate the comment. Cheers Oz

Hi, the cost will vary greatly. Will depend on the surgeon and the country you are in. Hospital and anaesthetic costs need to also be factored in.

Thank you, Im happy you liked it. The second excision is another adventitial bursa.

I see, I thought the second is sth else as the location is not on the side. Do you also have some video or pictures of the excision of the intermetatarsal bursa?

@44moka22 I don't have a video of an intermetatarsal bursal excision. I know these are reported often with a neuroma. Interestingly, when I excise a neuroma, I rarely see the intermetatarsal bursa.

Can replace with sports tape

Hi Scott, yes it was performed under local in my office. I have a room I use specifically for procedures.

Hi, I usually keep patients in a cam boot or a post operative shoe for 3 weeks, and then get them into a sneaker.

Good to hear the right foot has healed.

Thank you for the very nice comment.

muchas gracias

Hi, continue taping as you have been in the corrected position. As the tissue heals and swelling goes down, the deviation most often reduces. This can take several weeks. Hopefully you'll be able to consult with your surgeon soon and have him assess progression of healing.

@DrOzanAmir Thank you so much!! This helps me tremendously! He did reply last night and said this. "I would would work on massaging the incision sites, and passively flexing the toe down, by holding at the base of the toe (not the tip) and flex the toe down for 15-20 seconds, 4-5 times. Will help stretch the soft tissue and allow the toe to sit better aligned. " Do you feel this will help as well? I will do what he said, plus I'll constitute to tape it down. He didn't mention how many times a day to do this 4-5 times. If you have any other suggestions, I would love to hear them. I have been post-op since May 31, 2024.

@scorson74 it's still early days. The massage and holding the toe down is a very good thing to do. If the stretch is not causing pain, you can repeat a few times a day.

@@DrOzanAmir Thank you a million for your help and responses! I will continue to head your advice!! Have a wonderful day!

@DrOzanAmir Hello again! I'm still very concerned that my 5th toe is not moving, going down or purchasing the ground. My Dr said the way he did it, it will eventually go down. It is rigid and stiff as a board, sticking to my 4th toe as it did when I had the pins taken out on July 9th. I still tape my toe down but had to give it a break because it became bruised on the top. My 4th toe also had a k wire, but that is not rigid like my 5th toe. I'm so upset and don't know if it will go down without a tendon release surgery. I'm your opinion, what are your thoughts since I'm 4 weeks out from wire removal and no improvement at all. I don't see my foot Dr until a week from this Tuesday (Aug. 20, 2024). I can't even wear a shoe with sides or any top to it as it would rub and squeeze my toes together. I trust your opinion, and you have been so great at answering my questions.

Hi Sharon, There shouldn't be a need for taping post surgery. However, some patients like the mild compression from the tape. I would check with your surgeon before trying this taping technique. I used kinesio tape (rock tape) and sport tape (5cm width).