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 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‘.

When to have bunion surgery when you are not in pain.

My usual readers will know that I do not advocate bunion surgery for cosmetic reasons. My postings usually talk about bunion surgery to relieve pain. Both kinds of pain, shoe pressure and joint pain. (That reminds me of a classic scene from the movie Blues Brothers when the bartender says, “we have both kinds of music, country and western!)

I had a patient come in this week that I scheduled for bunion surgery that was not having pain. However, she was not scheduled for cosmetic reasons alone. She had severe bunions. She complained of not fitting into some shoes but she was okay with wearing less stylish shoes that did not hurt her bunions.

So, why would I schedule surgery on her if she had no pain and she did not complain of not fitting into shoes that she wanted to wear?

Best Podiatrist Bunion Surgery without pain joint space narrowing1On x-ray, she had signs of osteoarthritis in her great toe joints. Arthritis from bunions means that the cartilage in the great toe joint gets worn away. Often there is pain associated with it but sometimes there is not.  (Click any picture to enlarge.)

Cartilage is the very smooth tissue on the ends of bones inside of the joints. Cartilage allows bones to glide with very little friction against each other in the joints.

On x-ray cartilage does not show up. It looks like clear space between the bones. When there is arthritis, the cartilage gets worn away and the bones appear closer together. When the cartilage is gone there is no space between the bones and they look like they are touching each other in the joints on x-ray.

Best Podiatrist Bunion Surgery without pain joint space narrowing2Best Podiatrist Bunion Surgery without pain joint space narrowing3Clinically, when the cartilage is gone, one feels a grinding of the bones or what we call ‘crepitus’ in medical terms. By the time one has crepitus there is almost always pain associated with movement.

The reason bunions result in arthritis with wearing away of cartilage, is the joint is not functioning correctly. The bones intersect at an angle to each other and that results in uneven forces on the cartilage, causing erosion over time.

Let’s go back to my surgery patient who has no pain… She had signs of arthritis on her x-ray. The space between the bones was decreased. We call this joint space narrowing.

I advised her that she should have surgery because once the cartilage is gone, there is no way to get it back. Once this happens, patients require bigger surgical procedures and have a worse prognosis to be pain free after surgery.

There are basically two types of cartilage one can have in their (toe) joints: Hyaline cartilage and fibrous cartilage. Hyaline cartilage is the good kind that you are born with in your joints, and the kind I referred to above that gets worn away when one has arthritis. The second kind, fibrous cartilage, is not really cartilage in my opinion. It is more scar tissue inside the joints. When we (doctors) say we will do surgery to increase the cartilage, this is the kind we are referring to. We drill holes in the hard bone inside the joint in order to create the growth of fibrous cartilage as scar tissue from the drill holes in the bone.

Fibrous cartilage does not function as well as hyaline cartilage, but it at least forms a spacer between the bones that is softer than the bones rubbing on one another.

So, to answer my question above, I recommend bunion surgery to patients that have no pain when there is progressive cartilage erosion, with arthritis forming in the great toe joint.

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