Welcome to CITYFOOTCARE.COM,
the 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 believe 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 competent and highly trained surgeons. 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 are 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‘.
As a Gout Patient, I found your BLOG interesting and educational! Having Kidney problems keeps me from taking the various medications recommened! I take Uloric, which is supposed to keep the Uric Acid under control.
Thanks for the comment Mom!
Everyone, meet my mom who unfortunately suffers from gout.
Uloric is one of the newest and best medications for chronic gout. It acts to block the chemical pathway in the production of uric acid. It does not, however, treat an acute gout attack.
Dr. Silverberg
Gout can really be a serious problem if not diagnosed early. This is a really nice post and tells almost everything about gout.
Hi Laura, I’m glad you liked my post on gout in layman’s terms.
Dr. S.
Hi Dr.
My father suffered from gout about 6 years since 2005 and recently getting severe. I just read from a website that sodium bicarbonate (baking soda added to water) can help reduce the attack. Is it true or it just a myth??
Hi Norul.
Im sorry I don’t know about this home remedy for gout. It I doubt it would work.
Dr. S.
Hi Dr. Silverberg,
Thank you for this article with the pictures which I found most interesting.
I have a condition very similar to this and have had two medical opinions both – diametrically opposite – the one doctor saying doctors are reluctant to do these ops because of the long healing period taken for the tow to recover.
Could you comment on that please?
Thank you.
Hi Rob.
Sometimes it is harder to heal after surgery when there are open sores caused by gouty tophi. On the other hand, it is almost impossible to heal these open sores when the tophi are not removed.
As long as there are no concomitant problems that contraindicated surgery such as peripheral vascular disease, venous stasis or lymphedema or others, then. I usually recommend the surgery to remove the tophi to patients.
Talk with your doctor about the risk and reward of surgery.
Dr. S.
Hi Dr.
I’ve turned 40 and recently have had numerus gout attacks. I take Prednisone to cure the attack not my choice but works. I have always had real bad bunions and everyone in my family has big bunions(always have to wear wide shoes since i was a kid). Would possibly getting the bunion surgery help relieve the gout syptoms like in your last surgery example.
Thanks.
Hi Jason.
It is possible that surgery will relieve some of the pain but you also need to address the metabolic problem underlying your grunt attacks.
Prednisone is a great drug for gout. It is a very strong anti inflammatory however, I prefer using Indomethacin for acute gout as it has less side effects and easier on the stomach / GI system. Ask your doctor.
Dr. S.
Fantastic article. I wish you were in my general area (Chicago) so I could see you for a consultation. I have some medical issues like psoriatic arthrtis, and others, one being horrible goat attacks. Personally I believe the gout has caused permanet damage to my ankle and it may well be surgery is my only option. I do take prednisone often for severe attacks when I am unable to even make it out of bed due to the severity of the pain. Is it possible for you to expand on the doses and side effects of oral prednisone? Again, great and informative article.
Hi Mike,
Unfortunately, I can’t answer your question on doses of oral steroids as they are dependant on individual patient needs.
The best advice I can give you is to consult an experienced rheumatologist.
Good luck.
Dr. S.
I was diagnosed w/gout in 06. It was a major attack that another Dr. Thought was a broken toe. But, when my broken toe did not heal, I finally consulted a Podiatrist. She nailed it! An injection in the joint & indomethecin and I was mobile in less than 24hrs. Yeah for Podiatry! I also got the diet,et al. However, she did not tell me about tophi. (I had not even heard the term until I read your article.) Needless to say I was shocked when this big lump appeared on my toe. Now what?? I have heart disease (two stents)and am afraid to take nsaids or ulloric for extended periods. Do your patients w/ CHD do well on ulloric? Is surgery a viable option? To be frank, I would rather amputate the toe than live with this pain. Thanks for keeping people like me informed-you do a great service.
-J.D.
Hi JD. Sorry to hear about yr foot pain and comorbidities. Wen pts cannot take systemic gout medication surgery often becomes the only option to treat painful joints. Surgery ranges from removing tophi and bone spurs to fusing joints and removing part of the joint to create space between the bones. Amputation is the last option and rarely indicated for gouty arthritis. Good luck.
I have experienced acute gout episodes in my big toe over the past 20 years but in the last couple of years they’ve become more chronic. Usually, treatment with oral or injected steriod type meds. will ease the pain but now I’ve noticed that the joint seems to have enlarged a bit and that using the full range of motion in a normal step is painful and is beginning to effect my gait. My question is, at what point should I consider surgery? I certainly don’t want to get to the point of disfigurement illustrated in your clinical photos.
Hi Stan. When to do surgery on a joint affected by gout is hard to comment on without evaluating the paitent. Gout destroys the joint very slowly. Often the amount of pain and frequency slowly increases. As the spin gets worse its a good idea to get periodic X-rays to evaluate. If there are tophi present they can be removed. Also, bone spurs can be removed. Finally when e joint is destroyed more invasive surgery is needed. We try to operate before these bigger surgeries are necessary.
Love your blog; I am in Los Angeles; can you recommend a dr for me to have my gout removed? Thank you so much.
It also just attacked my big toe and now I have that paste white stuff and I don’t like it..How can I get rid of that..
Thanks Again!
Jeaz
Hi. Thanks for reading my blog.
I don’t know a doctor in LA. Most foot surgeons should be able to remove gout tophi when they get large and painful.
Hello,
I have just had surgery to both big toes and left little toe to remove gouty tophi, unfortunately I have suffered a severe attack of gout during the healing process about 2 weeks after the surgery, I have read that antibiotics can bring on gout, I was prescribed antibiotics after the surgery and I also contracted a chest infection. Another dr also prescribed antibiotics, m question is has the antibiotics caused my severe gout attack Otis it the result of surgery.
Regards
Jim
Hi Jim,
It’s impossible to tell for sure the reason for your acute gout attack. It could be any of these vaiarables or others including diet and had hydration.
If you had a chest infection, the antibiotics were necessary regardless if they contributed to the gout attack.
The ‘stress of surgery’ can often bring on gout too.
Good luck. Dr. S.
What is the down time after Gavin surgery on big toe for gout
Gavin surgery?
Hi Dr. Silver,
I really appreciate this blog post about gout. I just had a second surgery on my foot in 3 months (the first was expected – Kidner procedure with flexor transfer). When I wasn’t progressing through PT as expected and severe pain developed, an MRI showed severe inflammation and coalition in the middle facet of the subtalar. The second surgery on Feb 6 for a subtalar fusion yielded a new surprise – gout crystals (and a subuquent uric acid blood test showing a 7.3) AND an unexpected tear on the PTT hindfoot (ironically, not where the surgeon previously pinned the PTT for the first surgery). The concern is the gout. I’ve adjusted my diet (which wasn’t too bad to begin with), and my Primary Doc just put me on Allopurinol (which I understand can increase gout on a temporary basis). I want to do my best to ensure that this second surgery is successful, and my surgeon (who is a nice guy) is a bit hesitant to give me a straight answer. I’d really love to hear your insight on: 1) Gout affecting the PTT repair and subtalar fusion; 2) Is Allopurinol a bit premature at this stage since it can temporarily increase gout attacks; 3) The use of Indocin during this critical healing phase, if I THINK I have gout attacks. I’d like to use the information you provide to take back to my surgeon and Primary Doc. Thank you for your help!