Welcome to CITYFOOTCARE.COM,
Lawrence Silverbergthe Internet home of Drs. Emanuel Sergi and Lawrence Silverberg, the most compassionate and skilled foot doctors in the New York City Metro area and the country.

Dr. Silverberg is Board Certified by the American Board of Podiatric Surgery. Our office is conveniently located in Midtown Manhattan near Grand Central Station.

We take great pride in providing excellent medical care along with great bedside manner and take the extra time to explain your problems and the treatment options in detail.

At City Footcare we treat all problems related to the foot and ankle. We use state of the art diagnostic and therapeutic equipment.

The doctors believes in patient education, and patient participation in their care. We take pride in spending time with our patients and listening to them. Our patients never feel rushed. We also take the time to explain patients problems in detail and spell out explicit treatment plans.

When your problem requires surgery, you can rest assured that you are in the hands of a competent and highly trained surgeon. Drs. Sergi and Silverberg have been called the best foot surgeons in NYC and the best bunion surgeons in NYC. The doctors perform all foot and ankle surgery including traditional open surgery, minimally invasive surgery, laser surgery, radio frequency surgery and extra-corporeal shock wave therapy. Drs. Sergi and Silverberg are experts in all aspects of foot surgery. They are very detail oriented from start to finish. A good surgical outcome starts prior to entering the operating room. After expertly diagnosing patients’ conditions, they plan out the procedures with great skill. In the operating room they are skillful and precise. they also take into consideration aesthetics with incision planning and plastic surgery type suturing techniques.

They is hospital and surgery center affiliated.

To resolve all of your foot and ankle problems, simply look around this site and make an appointment with Drs. Sergi and Silverberg today. Your feet will be glad you did!

Please see the medical DISCLAIMER on the ‘about this blog page‘.

Common misconceptions about foot surgery

While I was writing my last post on hammertoe surgery it occurred to me to write a post on common misconceptions of foot surgery.

(Don’t feel like reading a long post? Skip to the last paragraph for a quick summary.)

1) The first one was one that I mentioned in my last post: that extra skin left behind in surgery reabsorbs. This is preached by many foot surgeons but is entirely untrue. Skin left behind remains extra skin after the swelling and scar tissue go down. It is true in the short term that you may not notice it because the area is swollen and the skin is expanded but once the size of the area goes down you still have extra skin.

A small exception to this is when we do hammertoe surgery for corns, sometimes we have to leave part of the corn behind because the skin incision would be too large to close if we cut out the whole corn. After the hammertoe surgery, the pressure and rubbing on the shoe that caused the corn is gone. In this case, the thick hard skin that makes up the corn will go away after surgery. However, this assumes that the correct amount of skin was removed, including the corn. If extra skin remains at the incision, even though the hard part will go away, the extra skin will not go away.

2) The next misconception is also somewhat of a cosmetic one. Many foot surgeons say they put the incision for bunion surgery on the top of the foot because if they put it on the side where it is hidden more, it will rub on the shoe and cause discomfort. Last time I looked at a shoe it encountered the foot on four sides not just one. The real reason doctors put the incision on the top of the foot for bunion surgery is just because they were taught that way when they learned surgery. It also makes it slightly easier to do the surgery, so the surgeon can more easily access the side of the great toe joint closer to the second toe in order to release the soft tissue contracture there. This creates an unsightly scar when looking down on the foot. A much more cosmetic way to do it, is to put the incision on the side of the foot so when looking down you don’t see the scar. With some finesse, I can still easily access the other side of the joint and if I need even more access, I can make a tiny incision between the first and second toe that is barely noticeable.

3) The next misconception: minimally invasive bunion surgery (or other minimally invasive foot surgery) is superior to regular open surgery. The truth is quite the opposite! Minimally invasive surgery entails using a small drill to cut the bones through small stab incisions while visualizing the drills under real time x-rays (Fluoroscopy). This type of surgery is very imprecise as to how much bone is removed and where the cuts are made. I have seen many of these patients have complications due to taking out too much bone and shortening the metatarsal too much, or even not taking enough bone. In addition it is impossible to fixate the cut bone with screws in order to get the bone to heal in the proper place. Some of the doctors that do this type of surgery use ‘percutaneous pins’ in order to hold the bone. This means the pins go through the skin and into the bone. The pin remains sticking out of the skin for 4 to 6 weeks after surgery in order for the bone to heal. The downside to this is that you need to keep the foot dry the whole time the pin is sticking out. Also, the pin exit point creates an additional scar. Additionally, as long as the pin sticks out through the skin, a patient may get a “pin tract infection”. This is when the bacteria from outside the body goes down the pin and into the foot, and into the bone. When you get bacteria or infection in the bone you have a serious problem and need the bone removed, the use of IV antibiotics and usually requires hospitalization. When a screw is used it is completely inside the foot and a patient may get the foot wet after about one and a half to two weeks. Most doctors that perform minimally invasive surgery tell their patients that they will be back to wearing shoes and back to activity faster than traditional open surgery. This is usually not true as they recovery in a similar amount of time.

4) Next misconception: if your doctor tells you that you’ll be back to normal shoes and normal activity in anything less than three or four weeks when he/she is doing bone surgery (and mostly any other foot surgery), he/she is lying to you. It takes 4 to 6 weeks for bones to heal and be strong after they are cut during surgery (or when they are fractured in an injury). After bone surgery, the patient should be immobilized in a boot or a surgical shoe for this 4 to 6 week period in order to allow the bones to heal properly. Occasionally, people wear a brace for only 3 weeks, but that is more unusual, as almost all of my patients wear it for 4 weeks. Whenever bones are cut, and with any other surgeries, there will be scar tissue that forms in the operative site. The doctor will call this “induration”. This induration will be present for 3-6 months and many times up to a year. During this time, the surgical site will feel hard and stiff. Your doctor may prescribe physical therapy after surgery to break up some of these adhesions. All surgeries produce this scar tissue. It does not mean that you will not be able to perform activities or not wear shoes, but I tell my patients that this will be present and they will not be able to wear all shoes or perform all activities due to it.

5) The last misconception that I hear patients talk about is that foot surgery is extremely painful and even more painful than other types of surgery. The truth is that foot surgery is unique compared to surgery on other parts of the body because you have to walk on your foot postoperatively. This weight bearing and not elevating the part of the body does cause slightly increased pain and throbbing. There are surgical techniques that I employ in order to reduce the amount of pain postoperatively. The amount of pain that patients experience starts with how the surgeon handles the tissue during the surgery. In my residency I was fortunate to work with plastic surgeons that taught me unique tissue handling skills that reduce postoperative pain and swelling. Most of my patients experience moderate to no pain after surgery. While I cannot guarantee that for everyone, I invite potential patients to read my reviews in Google. Many of them state that they had little to no pain, or experience less pain than they expected to have after foot surgery. Additionally, I often prescribe a cold therapy device to be used postoperatively. I also prescribed painkillers that reduce the discomfort after surgery greatly. Most people only take these for 1-3 days after surgery. Having less pain really enhances the surgical experience and lets patients return to more normal activities sooner. For example, most of my patients that have desk jobs are able to go back to work on Monday after doing surgery on Friday.

As you can see, there are many misconceptions about foot surgery. I have generalized my descriptions, however, many variables will affect each individual patient. When patients come in for their preoperative appointment, I am very thorough and go over the following: Alternatives to surgery, risk versus reward of surgery, benefits of surgery, pre-operative planning, postoperative course, potential for further surgery in the future, preventative care against recurrence of the deformity, and any other unique characteristics for the individual patient. I will answer all of your questions and make you feel comfortable about having surgery prior to moving forward with the actual surgery.

To summarize the most important points of this blog: 1) Don’t do minimally invasive surgery. (Yes, it is THAT bad that I can generalize). 2) There are ways to reduce postoperative pain. 3) Have realistic expectations about recovery. 4) There are ways to reduce surgical scarring. 5) There are surgical techniques to make foot surgery more cosmetic while getting rid of painful foot deformities.

 

15 Responses to Common misconceptions about foot surgery
  1. Myra Shapiro
    September 16, 2011 | 7:10 pm

    I’ve had hammertoe surgery 5.5 weeks ago. The pins will be removed next week. I’m anxious to begin strenthening my toes. Would you recommend starting physical therapy the same week my pins are removed? One toe looks floppy now (with pin in it). If one toe turns out to be floppy, how would you correct it?(hopefully without further surgery!)

    I look forward to your immediate reply. Thank you.

    • drsilver
      August 20, 2012 | 2:12 am

      Hi Myra.

      I recommend physical therapy after foot surgery no earlier than four to six weeks after surgery so you are okay to start.

      If a toe is floppy after hammertoe surgery, usually the only way to fix it is to fuse the bones with another surgery.

      Dr. S.

  2. Amy
    February 8, 2012 | 11:26 pm

    I wish I found found your website a 5 weeks ago. I recently had digital arthroplasty of the 4th and 5th toes on my left foot. My surgeon said it was non-invasive and I would have no pain that Tylenol would take care of, so she sent me home with no medication. I see that you prescribe pain medication and even antibiotics sometimes to ensure a comfortable and healthy recovery. My pain was so severe, that I actually had trouble breathing and wheezing, and an elevated blood pressure. My calls to her answering service went unanswered and whe I finally did get to see her three days later, the x-ray revealed that the 3rd metatarsal was actually fractured. Not sure how that happened since i had to be carried everywhere due to the excrutiating pain. When she did take the wrap off I was mortified to see the butchering that had been done to my toes. It has been 4 weeks now and I am still traumatized by the experience, but I am now looking for information to gather for a 2nd opinion. I am in more pain than I was before the surgery, the surgical shoe is making me walk funny and my ankle is now a concern and she has closed my case as successful and said further follow up was not necessary. I am in Washington DC and from reading your various articles and comments, it may be worth a 4 hour drive for a consult with you. At the very least, thank you for all the information you have provided. I am compiling information which will help to answer questions when I do find another podiatrist.

    • drsilver
      August 20, 2012 | 1:38 am

      Hi Amy.

      I’m really sorry to hear about your terrible experience. The fact that your doctor called your surgery “non invasive” leads me to think that it was the minimally invasive surgery that I discuss in this blog post. I can’t be sure though.

      The best advice I can give you is to find a really good podiatrist that can do reconstructive surgery to fuse the toe joints and even possibly add bone graft if necessary.

      Good luck. Dr. S.

  3. swati.chopra
    February 15, 2012 | 11:43 am

    That was a nice description Dr Lawrence, I am a doctoral student doing research in foot and ankle surgeries and I find your blog quite practically useful.
    Keep sharing your experiences with us.:)
    Swati

    • drsilver
      August 13, 2012 | 2:15 am

      Hi Swati, thanks for the nice comment. I love to see people from all over the world reading my writings.

      Lawrence

  4. Monica Bernot
    April 5, 2012 | 2:40 pm

    Dr. Silverberg:
    First of all I would like to congratulate you and express my aprreciation for your honesty and sincerity (quite difficult to find them in doctors). I’ve been doing research on foot surgery (bunion and hammertoe)specially on MIS, and thanks to your provided information about it, I have learned important and significant pros and cons about this new technique. I’m from Charlotte, North Carolina, and I would like to ask you if I can be referred by you to some doctor (close to my area) that performs this type of surgeries with your professionalism.
    Thank you so much in advance for your time.
    Monica Bernot

    • drsilver
      July 23, 2012 | 2:14 am

      Hi Monica. Thanks for the kind words. Unfortuanly I don’t know any doctors in your area. Good luck with your search though. As you can tell, I’m very against MIS except in rare occasions.

  5. Sharon Collier
    July 2, 2012 | 12:09 am

    I am so impressed with your website and your before and after pictures. You sound very qualified! I have bunions, corns & hammertoes. In other words, my feet are a hot mess! ! ! However, I am very nervous about having any type of surgery. If you can do to my feet what you claim to have done for these other people, you would definitely be a God sent to me. I woud like to set up an consultation to see you and get your medial opinion on what I should do. Thaks for a very interesting read.

    • drsilver
      July 20, 2012 | 11:30 pm

      Hi sharon, thanks of the kind words.

      I hope to meet you no discuss how surgery can fix your “hot mess”. If you’re interested in coming in, please call my office to set up an appointment.

  6. Suzie Gray
    September 29, 2012 | 1:42 am

    Thank Y’all for Explaining so well, DrSilverberg! Six weeks ago I had Wedge in Bunion and 3 pins in Hammertoes, Baby toe Straightened too. Was 4 Hr Procedure. Seemed all going well but until Pins taken out this wk. X-Ray same Dr Said. I have to wait 3 wks now w new X-Ray and have Therapy 3x wk. Dr said ROM need and swelling to come down. I never had lot of swelling til this Wk. Should I have been doing exercises to avoid stiffness? I am bit feeling I could have helped myself. I hope to be able to be on ice in Dec. I teach Skating but will do minimal. Am worried a bit too. I hope I have explained well enough . Thank You so much !
    Suzie Gray

    • drsilver
      October 8, 2012 | 10:08 pm

      Hi Suzy.

      I recommend staying non weight bearing with crutches for 10-12 weeks after base wedge osteotomy procedures.

      I have found less time non weight bearing leads to first metatarsal elevation and subsequent joint stiffness.

      I almost always prescribe PT after base wedge procedures.

      Good luck.

      Dr. S.

  7. Martha Maguire
    October 5, 2012 | 1:41 pm

    Dear Dr Silverberg
    I had surgery to remove a Morton’s Neuroma in April, (in the UK). I have Diabetes Mellitus. A lot of scar tissue has developed in my foot which makes it now more painful to walk than before the op. The incision was in the top of my foot. Is there any therapy which is helpful in breaking down scar tissue? Being unable to walk far has radically affected my life in all areas. Although my 2nd R toe is almost numb, around the scar is also painful; it’s so tight that it feels like cable-ties around my foot causing constant discomfort, and the skin between R1&2 toes is sewn slightly together at the ‘web’. My surgeon has been most unhelpful; he says it just happens sometimes. Have you any advice? Thank you very much.

    • drsilver
      October 8, 2012 | 9:39 pm

      Hi Marhta.

      Sorry to hear about your complications. One thing I always tell my patients with any surgery is to expect 6-12 months of scar tissue called induration. It’s occurs with every surgery, not just foot surgery.

      After six months I often will treat excessive scar tissue with steroid injections into the area.

      Physical therapy post operatively works well too.

      Discuss this with your surgeon or with a doctor you go to for a second opinion.

      Let us know how you make out.

      Dr. S.

  8. Katy Thompson
    September 1, 2013 | 1:18 am

    DR. S

    I had a endoscopic plantar fascia release three months ago. In the time after recovering from surgery and my doctor told me I could go back to regular activities. So I did, but I found that I was still having pain in my foot. So went back to my doctor and he told me I had scar tissue. Well this pain is unbearable. It throbs and I am unable to walk. I have been doing physical therapy for a month and that is not helping soften the scar tissue. Is there a chance that I will have to go back in for surgery to scrape out the scar tissue? Is it worth it, or is it something that I will just have problems with the rest of my life?
    Thanks,

    Katy

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