The PODdoctors with Dr. Dauphinee and Dr. Hussain

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the prevalent issue of athlete's foot, its symptoms, and the best treatment options. They provide a detailed analysis of three primary treatment methods for athlete's foot: topical antifungals, moisture control, and oral antifungals. Highlighting the importance of treating even minor symptoms, particularly in diabetic patients, they share professional recommendations to prevent severe complications.

Quotes

• "It’s been estimated that one in four people have some level of fungal pathology going on at some time or another. So super common athletes foot, it's a fungal infection typically of the interspaces between your toes because it stays moist, and it typically presents with burning, itching, and scaling of the skin.” -Dr. Raafae Hussain

• "People will have athlete’s foot for years and not realize that they have it because they don't feel the itching. We have to cure them of that thought process and say, no, that's athlete's foot until proven otherwise.” -Dr. Damien Dauphinee

Top Takeaways:

• Topical Antifungals: Start treatment using topical antifungals like fungifoam that pull moisture off the foot while killing the fungus.
• Moisture Control: Employ methods for controlling foot moisture including moisture-absorbing shoe liners and antiperspirant products like Drysol.
• Oral Antifungals: For severe, recalcitrant cases, consider oral antifungals but be mindful of their potential side effects on the liver.
• Importance for Diabetics: Diabetic patients must pay attention to athlete's foot due to their higher risk of complications like foot ulcers and infections.
• Treating Shoes and Feet: Clean shoes thoroughly using products like Lysol and ensure they are dry before use to prevent re-infection.

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss one of the most common foot ailments: plantar fasciitis. This episode's comprehensive guide covers everything from the basics of plantar fasciitis to the most effective treatments currently available. The doctors discuss the anatomy and mechanics of plantar fasciitis, emphasizing the importance of distinguishing between heel spurs and plantar fasciitis pain. They also highlight the significance of stretching, the use of proper orthotics and footwear, and the benefits of steroid injections.

Quotes

• "Orthotics are about architectural support, not just cushioning. Stiffer devices are more effective than gel insoles for plantar fasciitis.” -Dr. Raafae Hussain

• "Standing calf stretches are technique dependent, and that's where the ProStretch shines by leveraging gravity for optimal stretch.” -Dr. Damien Dauphinee

Top Takeaways:

• Steroid Injections: Steroid injections can help in reducing inflammation and pain, making it easier to follow through with other treatments like stretching and wearing orthotics.
• Advanced Treatment Options: For chronic cases not responsive to conventional therapies, treatments like Topaz and amnio injections offer promising results.
• Diagnostic Imaging: Utilizing tools like ultrasound to measure plantar fascia thickness can aid in determining the severity of the condition and tailoring the treatment plan accordingly.

What You Will Learn:

• Effective stretching exercises, such as standing calf stretches, towel stretches, and using tools like the ProStretch, play a crucial role in managing plantar fasciitis.
• Choosing well-made, supportive shoes and custom orthotics can significantly alleviate plantar fasciitis symptoms. 

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, evaluate the complexities of an Achilles tendon repair using a Flexor Hallucis Longus (FHL) tendon transfer. This particular case involved a patient with a history of clubfoot, multiple surgeries, and a significant Achilles tendon rupture. The doctors explain their surgical approach to repairing the damaged Achilles tendon by harvesting the FHL tendon. They emphasize the importance of this technique in providing the necessary strength and functionality for the patient to regain a normal gait. 

Quotes

• "We did what's called an interference screw or anchor. We drill a pocket hole for that tendon to go through, and then we'll put an anchor in right next to it that will hold that tendon up against that bone without any type of limitations.” -Dr. Raafae Hussain

• “The non-absorbable suture will tear your gloves and tear your finger before it'll break. You can really crank on this stuff, which is perfect for stout, tender repairs where you're going to be putting a tremendous amount of force through this tendon.” -Dr. Damien Dauphinee

Top Takeaways:

• Achilles Tendon Repair with FHL Transfer: The utilization of the FHL tendon to enhance the strength and functionality of a damaged Achilles tendon.
• Surgical Case Details: Insight into a complex foot surgery involving a patient with previous clubfoot reconstructions.
• Advanced Surgical Techniques: The use of advanced techniques, such as the whip stitch and interference screw, to ensure successful tendon transfer.

What You Will Learn:

• The importance of post-surgery protocols, including non-weight bearing periods and early active range of motion exercises.
• Surgical procedure steps and the reasoning behind specific surgical choices.

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a case involving a severe Achilles tendon injury in a young athlete. They highlight the importance of having backups for backups when relying on imaging, as MRIs can sometimes be misleading. Dr. Dauphinee and Dr. Hussain explain the surgical procedure they performed, including the use of a cadaveric calcaneal Achilles graft. They also discuss the post-operative care and rehabilitation process. 

Quotes

• "When tamping the bone you can use screws, wires, staples, plates, but I think the most common is a single screw.” -Dr. Raafae Hussain

• “The moral of the story from a surgeon's standpoint is, MRIs can lie to you Have a backup for your backup.” -Dr. Damien Dauphinee

Top Takeaways:

• Cadaveric Achilles grafts can be a viable option to bridge extensive gaps.
• Encouraging interdisciplinary learning through real-life cases is vital for medical professionals' growth and preparedness for complex surgeries.

What You Will Learn:

• Postoperative care involves lengthier immobilization and physical therapy when using cadaveric grafts, highlighting the need for tailored recovery protocols.
• MRIs can sometimes provide misleading information; it's important to be prepared with multiple treatment plans.
• Proper fixation using screws and consideration for nerve location, such as sural nerves, is crucial during Achilles tendon surgery.

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, cover the intricacies and surgical treatment of fibular nerve release, a crucial procedure for patients experiencing various complications often associated with nerve entrapments in the lower limbs. They discuss the nitty-gritty of podiatric surgery, specifically the peroneal, or technically the fibular nerve, and its susceptibility to injury or entrapment. Doctors Dauphine and Hussein then discuss the surgical nuances of nerve release, providing critical insights into how such procedures substantially improve patient outcomes.

Quotes

• "Nerve flossing is a really great technique. We'll get folks into the physical therapists and have them start nerve-flossing as quickly as we can. Usually, right after we get the stitches out at two weeks.” -Dr. Raafae Hussain

• “You've got to always keep in mind that when patients are complaining of burning, stabbing, shooting pain, tightness at nighttime, that is nerve-related pain for sure.” -Dr. Damien Dauphinee

Top Takeaways:

• Fibular nerve release is improving patient outcomes, with modern technology playing a pivotal role.
• Detailed nerve anatomy understanding and careful surgical techniques are essential for the successful treatment of the fibular nerve and its branches.
• The surgical approach to decompressing the fibular nerve involves meticulous dissection 
• Diagnostic blocks are a helpful tool in identifying specific nerve entrapments that could contribute to conditions like restless leg syndrome (RLS).
• Nerve flossing is crucial to prevent adhesions and maintain nerve health.

What You Will Learn:

• Surgical procedures to address nerve entrapment
• Using diagnostic blocks as a tool
• How the application of protective materials like umbilical cord tissue prevent scarring and promote healing
• Postoperative care that encourages movement

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss bunion surgery and its various outcomes, especially focusing on revision bunionectomy. They explore the numerous techniques to correct bunions, emphasizing the importance of matching the surgical approach to the patient's specific condition. The doctors also suggest that one solution does not fit all, and the choice of procedure can greatly impact long-term satisfaction and functionality. They also suggest personalized surgical plans, which are crucial for achieving the best outcomes in foot and ankle health.

Quotes

• "The difference between doing an open versus MIS is minimally incisional surgery. The benefit is that you don't have a long incision.” -Dr. Raafae Hussain

• “Most bunion surgeries that fail, are a failure of the choice of the bunionectomy.” -Dr. Damien Dauphinee

Top Takeaways:

• The success of bunion surgeries largely depends on selecting the proper procedure that aligns with the patient's degree of deformity and clinical presentation.
• The Lapidus Bunionectomy: among other techniques, is becoming increasingly popular for treating severe and hypermobile bunions
• Minimally invasive surgeries (MIS) for bunions require careful patient selection, with ideal candidates being young, healthy, and free of complicating factors like smoking or diabetes.
• Revision bunion surgeries are sometimes the consequence of an initial procedure that did not sufficiently address all aspects of the deformity
• Fusion of the big toe joint can be a highly effective solution for long-term relief in patients with recurring bunions or persistent joint breakdown.

What You Will Learn:

• Different options for revision bunion surgery
• Common complications and concerns
• Patient Selection Criteria for MIS Bone Healing
• How to Choose the Right Bunion Surgery and Surgeon

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, dive deep into a lesser-known yet intriguing condition called chilblains. Characterized by itchy, red, and tender skin lesions, chilblains is often exacerbated by cold, damp conditions, without necessitating freezing temperatures. Leveraging their practical experience, Dr. Dauphinee and Dr. Hussain delineate the distinction between chilblains and related conditions like Raynaud's phenomenon and frostbite. The doctors also provide tips for prevention and treatment, including wearing thick socks, using topical medications, and avoiding hot foot baths.

Quotes

• "When chilblains occurs, you can put your feet in lukewarm water for a certain period of time. Not blazing hot, not boiling. You just want them to be lukewarm. If this is a more chronic problem, it flares up every couple months, or during the cold weather, your doctor might prescribe something topical.” -Dr. Raafae Hussain

• “Between chilblains and frostbite, the difference is temperature. So it doesn't require a frigid 20, you know, in the teens Fahrenheit to cause chilblains. It could, like we talked about, be in the forties outside.” -Dr. Damien Dauphinee

Top Takeaways:

• Chilblains: a condition characterized by itchy, red, and tender skin lesions, often exacerbated by cold, damp conditions, without necessitating freezing temperatures.
• Individuals with a history of Raynaud's or who are smokers may be more susceptible to developing chilblains.
• While self-limiting, recommendations include lukewarm foot baths, topical steroids, or vasodilators like topical Nitroglycerin for acute cases. Systemic medications are considered for more chronic issues.
• Appropriate insulative clothing and thick socks are key preventive measures during cold weather, especially for slender individuals who may be more prone to the condition.
• Patients with sensory loss due to neuropathy should take extra caution when using heat-related treatments to prevent accidental burns.

What You Will Learn:

• What is chilblains?
• The difference between chilblains and frostbite
• Treatment options and prevention tips
• Neuropathy Consideration

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the proper technique for applying wound dressings and the different types of wounds commonly seen in podiatric medicine. They emphasize the importance of maintaining a balanced, moist wound environment and provide tips for choosing the appropriate dressing based on the level of moisture or drainage. The doctors demonstrate a simple dressing change using Hydrofera Blue and Coban wrap, highlighting the importance of sterile technique and proper dressing application. They also debunk the myth that wounds need to be aired out and explain the benefits of modern wound dressings.

Quotes

• " There's a lot of different types of wounds out there, but the dressings themselves are fairly similar. So there's primary intention healing wounds or secondary intention healing wounds, and there's tertiary intention healing wounds. Primary are your surgical incisions. The dressings on those are very simple. Secondary intention healings are like your sores and ulcers or big gouges. And tertiary intentions are more of like a delayed primary healing type of surgical incisions.” -Dr. Raafae Hussain

• “It still seems to be deeply embedded in the brainstem of human beings that you need to let wounds air out. They don't need to be aired out. The dressing needs to be applied. And you need to change that dressing in a reasonable schedule to prevent maceration, which is the white stuff, and to prevent things from drying out. So if there's got to be a happy medium there somewhere where you're changing the dressing frequently enough that you're avoiding some of those complications we got way better wound dressings and capabilities in 2023.” -Dr. Damien Dauphinee

Top Takeaways:

• Proper wound dressing technique involves moistening dry wounds and drying excessively moist or draining wounds.
• Hydrofera blue is a versatile dressing that absorbs drainage, provides antimicrobial properties and helps maintain a balanced wound environment.
• Coban wrap is an elastic dressing that can be easily molded and provides secure coverage for the wound.
• It is important to maintain sterile technique during dressing changes and to avoid using household scissors or unclean instruments.
• Modern wound dressings have advanced significantly, and the belief that wounds need to be aired out is outdated.

What You Will Learn:

• How to do a wound dressing change 
• Explanation of different types of wounds and dressings 
• Debunking the myth of letting wounds air out 
• Qualifications for being considered homebound for Medicare patients

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a case of complex regional pain syndrome (CRPS) type two. They explain the difference between CRPS type one and type two, and how a discrete nerve injury can be misdiagnosed as CRPS. They share the story of a patient who developed debilitating nerve pain after bunion surgery and was suffering for six and a half years before being properly diagnosed. The doctors perform a diagnostic block and identify a specific nerve injury. They then perform a surgical procedure to cap the damaged nerve and bury it in muscle to prevent the development of a stump neuroma. The patient experiences significant pain relief and is on the path to recovery.

QUOTES:

"As long as that end nerve is no longer connected to the brain, that's going to wither and shrivel up and go through Wallerian degeneration and go away." -Dr. Damien Dauphinee

“Complex regional pain syndrome. There are two versions. There's a type one, which is nondescript, there's no specific nerve pathway, and there's a type two, which it's more associated with a specific nerve pathway, usually associated with an injury.” -Dr. Raafae Hussain

Top Takeaways:

• Complex regional pain syndrome (CRPS) can be misdiagnosed if a discrete nerve injury is not identified.
• Discrete nerve injuries can cause chronic pain and other symptoms similar to CRPS.
• Surgical intervention, such as capping the damaged nerve and burying it in muscle, can provide significant pain relief for patients with a discrete nerve injury.

What You Will Learn:

• Differentiating between general CRPS and discrete nerve injury
• Options for nerve reconstruction or capping
• Preventing stump neuroma
• Importance of identifying discrete nerve injuries in CRPS patients 
• The need for psychiatric care in some cases 
• The importance of multimodal pain management 
• CRPS Warriors support group for patients

Resources:

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In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the excision of a lipoma, a benign fatty nodule that can cause pain in the foot and ankle. They explain that lipomas are commonly found in the subcutaneous layer of the foot and ankle, and while they are usually benign, they can become painful. The doctors emphasize the importance of clinical diagnosis, as an MRI may not show whether the lipoma is causing pain. They also mention that lipomas are often misdiagnosed as underlying ankle sprains. The surgical procedure involves making an oblique incision along the relaxed skin tension lines, carefully dissecting the lipoma, and removing it as a solid piece. The doctors highlight the need to identify and protect the lateral branch of the superficial peroneal nerve during the procedure.

QUOTES:

"You can get something called lipidema, and that's a different animal where a known normal fatty deposit can become painful. A lipedema can be a real problem in different parts of the body, and that's a normal place for adipose tissue. But if it becomes painful, sometimes we have to consider removing it. I've not appreciated that as much over the years as I do now. I think I'm seeing that that can become a source of pain all by itself in some patients. And I think it's probably a poorly understood problem." -Dr. Damien Dauphinee

“So we get the closure on this and you'll see we'll do deep to superficial. The reason we do that is so the knot stays buried. It's not close to the skin. So when she ends up tying this, you'll see that the knot will stay nice and low and hopefully the patient won't ever feel it. And then as time goes on, the weeks go on, the stitches will dissolve away, and hopefully no more score. There no more palpable nodule there using.” -Dr. Raafae Hussain

Top Takeaways:

• Lipomas are benign fatty nodules that can cause pain in the foot and ankle.
• Lipomas are commonly found in the subcutaneous layer and can be misdiagnosed as ankle sprains.
• Clinical diagnosis is crucial, as an MRI may not show whether the lipoma is causing pain.
• Surgical excision involves making an oblique incision along the relaxed skin tension lines and carefully dissecting the lipoma.

What You Will Learn:

• Surgical procedure for lipoma excision 
• Importance of dissecting carefully to avoid nerve damage 
• Closure technique: two layers, running subcuticular, deep vertical mattress 
• Superficial dressing choice: zebra foam
• Post-op shoe preference
• Risks: injury to lateral dors-cutaneous nerve branch, stunt neuromas

Resources:

Visit our website: https://thepoddoctors.com/