About Dr. Marc Katz Expertise All medical and surgical problems of the foot and ankle.
Specializing in Pain Management of the Foot & Ankle using Advanced Cryosurgical techniques. Also woundcare and limb salvage.
Experience I am a Podiatrist in private practice for 17 years in Tampa Florida
Organizations
American Board of Podiatric Surgery
Fellow, American College of Foot and Ankle Surgeons,
American Podiatric Medical Association,
Florida Podiatric Medical Association,
American Professional Wound Care Association,
Cryostar certified in Foot Cryosurgery
Publications
http://ezinearticles.com/?Understanding-Heel-Pain-and-Treatment-Options&id=270285
http://ezinearticles.com/?New-Relief-for-Foot-Pain-Due-to-Diabetic-Neuropathy&id=438090
http://ezinearticles.com/?Permanent-Relief-for-Ingrown-Toenails&id=387593
http://ezinearticles.com/?Foot-Cryosurgery-for-Plantar-Fasciitis,-Heel-Pain,-Mortons-Neuroma-and-Neuropathy&id=261571
Education/Credentials
I am a board-certified Doctor of Podiatric Medicine (DPM) and a certified Foot Cryosurgeon
Question Hello Dr Katz,
Here's the long story:
In December of 2007, I tripped (over a black cat) while wearing poorly fitting, high-heeled clogs. I heard and felt a "pop" and was immediately unable to weight-bear. The ER physician felt I had sustained a Lisfranc injury and referred me to a orthopedic.
That orthopedic performed an MRI after placing me in a cast. The MRI showed numerous "hot spots" and a "suspicious for full tear" of the Lisfranc ligament.
Since it was a "partial" tear, I was prescribed a shortleg cast for 6 weeks followed by a camwalker for 8 weeks. After the camwalker, I was cleared to resume normal activity and at week 12 he cleared me to return to my running marathon training schedule. During this time, I continued to have pain which he assured me was normal due to the severity of a Lisfranc "sprain". At the end of the 5th month, he performed another weightbearing xray - which showed a 4mm dislocation if the Lisfranc interval. I was referred to a specialist, a wonderful man who has performed quite a few of these (Dr Robert Mills, Holy Cross Ortho) and had a ORIF requiring two screws with excellent reduction. 6 weeks non weight-bearing followed by 16 weeks in camwalker - he removed the hardware at 20 weeks. He told me (in a way not to insult or accuse another physician) that I should have been in an orthotic and running should not have been addressed for a year. Also, the first weight-bearing xray performed in the first office revealed diastasis and the classic "fleck" sign.
I was doing ok until about 6 weeks ago when I began to experience increasing pain and decreasing tolerance to standing and walking. I have not run since right before my consult with the surgeon. I have been VERY active; running 7 marathons and work as a pacemaker/defibrillator company rep (lots of OR time). During my follow up visit I had a series of xrays done and they reveal arthritis and am now faced with a possible 3rd surgery to perform a fusion. Complicating this matter is that I also sustained a bunion at the time of the injury.
My doctor has offered to try a brace, but it wont change the arthritis. If the pain continues to worsen, a fusion will be needed. I really like my doctor and trust him, but the news on this injury, especially when misdiagnosed and late ORIF is performed looks bleak.
My question is:
What are my chances of achieving a "minimal pain" state that would allow me to work and walk pain-free? I have accepted that my marathon and any running days are behind me, but I sure would be happy to be able to walk pain-free.
Because I work in medicine, I completely understand that I need to have realistic expectations without losing hope.
I appreciate any advice you have.
Answer Hi Becky,
Based on the injury and all of the treatments, I would say that you will likely develop further arthritis and will likely always have some degree of pain. In some cases fusions will stop much of the pain. I would consider some aggressive physical therapy. Before fusion you might consider a custom ankle-foot orthosis. There are several types including a Ritchie and Arizona brace.
Sincerely,
Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem. It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice. Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan. No doctor/patient relationship is created or established here and may not be inferred through answers on this site. The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site. The questioner is only to act upon his/her own doctor’s orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.
