Ankle & Foot Surgery and Podiatry Services,
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Medical-Legal Areas of Expertise
Dr. Nakra has extensive experience in medical and legal aspects of foot and ankle cases including Independent Medical Evaluations, impairment ratings, chart/file reviews, expert witness and depositions. Areas of Expertise include Foot and Ankle Medicine and Surgery for Adults and Pediatrics, Total Ankle Replacement, Ankle and Pilon Fracture, External Fixation of Foot/Ankle and Leg, Foot/Ankle Sprain/Fracture/ Dislocation, Nerve Injury including Chronic Pain and Complex Regional Pain Syndrome, Arthroscopy, Diabetes and Foot/Ankle Pathology including Wound Care and Charcot, Calcaneus and Lisfranc Fracture, Lacerations and Puncture Wounds, Ligament Injuries/tears/ruptures, Tendon injuries/tears/ruptures Including ruptured Achilles tendon and Sports Medicine.
Arthroscopic surgery is a type of minimal incision surgery that is utilized to diagnose and treat many joint problems. This significant advance in joint care allows for a rapid return to improved activity without extensive incisions. All of our doctors have specialized training in ankle and foot arthroscopy and the OATS procedure.
Diabetic Ankle & Foot Care
People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious problems. The damaged nerves and poor blood circulation that often accompany diabetes ensure that there is no such thing as a minor cut, scrape, bump, or bruise on the foot when you have diabetes. These deficiencies in the nerves and blood supply lead to ulcers on ankle and feet – if. If not treated promptly and aggressively, these wounds act as portals of entry for bacteria leading to serious infections, which can result in amputations or even death. One of the more critical foot problems these complications can cause is Charcot arthropathy, which can deform the shape of the foot and lead to disability. There are treatment options for the wide range of diabetic foot problems. The most effective treatment, however, is prevention. For people with diabetes, careful inspection of the feet under the watchful eye of one of our doctors, is essential to prevention and management of damaging foot problems.
Digital X-Rays (Imaging)
Our offices can take digital x-rays in the offices. Any suspected fracture or injury to the foot and/or ankle can be promptly treated without having to go to the emergency room.
Disorders of the Skin & Nails (Ankle & Foot Dermatology)
Just about any skin disease or condition that affects the human body can occur on the foot or ankle. This may include ingrown toenails, psoriasis, warts, fungal or bacterial skin and nail infections, eczema, contact dermatitis and skin cancer. We commonly biopsy suspicious skin lesions and rashes as quite often skin cancer does manifest itself in the foot. These lesions are usually painless, and often there is a history of recurrent cracking, bleeding or ulceration.
Elective Ankle and Foot Surgery
Elective ankle and foot surgery are reserved in cases when less invasive procedures and treatments do not help with the problem. Although surgery is generally considered to be a last resort, when undertaken it can provide pain relief and allows you to resume the activities your ankle and foot problem has prevented you from enjoying otherwise. This includes bunions, bone spurs, painful nerves, congenital deformities, misaligned bones etc. We also offer in-office diagnostic testing to ensure that you have adequate blood supply to heal up these surgical incisions.
General Wellness Ankle & Foot
A change in your feet–whether on the skin, nails, or even how they feel–can be the first sign of a potentially serious problem. Our ankles and feet are easily compromised when our bodies feel threatened since we send blood to the internal organs and the brain before the extremities. In addition, our ankle and feet, at all times are subject to the constant pressure from the ground and the weight of the body. Some common red flags to watch out for are hairless feet and toes, cold feet, cramping, a sore that won’t heal, enlarged big toe, numbness, flaky itchy or peeling skin, yellow toenails etc. If you have been dealing with an ankle and foot ailment that has not responded to home care or if you would just like your ankle and feet checked, schedule an appointment with one of our doctors.General Wellness Ankle & Foot A change in your feet–whether on the skin, nails, or even how they feel–can be the first sign of a potentially serious problem. Our ankles and feet are easily compromised when our bodies feel threatened since we send blood to the internal organs and the brain before the extremities. In addition, our ankle and feet, at all times are subject to the constant pressure from the ground and the weight of the body. Some common red flags to watch out for are hairless feet and toes, cold feet, cramping, a sore that won’t heal, enlarged big toe, numbness, flaky itchy or peeling skin, yellow toenails etc. If you have been dealing with an ankle and foot ailment that has not responded to home care or if you would just like your ankle and feet checked, schedule an appointment with one of our doctors.
As we mature, our bodies change. In the feet, the nails grow thicker, the skin gets drier and the joints get stiffer. With advancing age, we also have had our share of sprains and broken bones which predisposes our elderly population to different forms of arthritis. Also, older folks often lose the padding that cushions their feet. This can lead to pain in the heel and ball of the foot. If you are over 65 years of age and are experiencing any foot and ankle issues, please contact our office to obtain medical advice from one of our well trained and “patient” doctors. We can diagnose the cause of your concern and pain and offer several treatment options.
Neurology – Ankle & Foot Care
Occasionally, the source of ankle and foot pain can be nerve-related and is caused either by direct irritation of a nerve (due to an injury, prior surgery etc.) or by health conditions (stroke, diabetes, cerebral palsy, Charcot Marie Tooth) that lead to nerve damage. When nerves are irritated or damaged, there is a characteristic numbness, burning, shooting, or stabbing pain that occurs. In addition, patients can also describe problems with movement, poor balance/coordination and difficulty in walking (footdrop). All these ankle and foot neurological issues are comprehensively managed by our physicians via education, custom bracing and specialized surgery if warranted. Dr. Nakra has extensive experience in diagnosing and correcting difficult peripheral nerve problems including surgical decompression of the nerves in the leg, ankle and foot for nerve entrapments; tendon transfers etc.
Orthotics & Custom Bracing
No more molds or casts. Our office staff is trained to create orthotics which are made specifically to each patient’s foot/ankle, helping ensure the best orthotic for each individual patient. In addition, we offer other conservative treatments which include a full spectrum of medical devices.including boots, casts, splints or braces to treat the area of pain.
Foot and ankle problems are common in the pediatric population. These can include, but are not limited to, sport injuries, skin and nail issues, growing pains, flattened arches, high arches, walking abnormalities, bunions and congenital anomalies such as clubfoot. Problems can be related to skeletal maturity and are fairly specific to the age of the child. Fortunately, our doctors have immense experience in this field and bring a range of non-operative and operative techniques specifically developed to address the distinctive needs of children, which include special attention to preserving the integrity of the growth plate, allowing continued growth and development of the ankle and foot.
Regenerative medicine is the “process of replacing or regenerating human cells, tissues or organs to restore or establish normal function”. This cutting edge technology holds the promise of regenerating damaged tissues by stimulating the body’s own repair mechanisms to heal tissues. Platelet rich plasma (PRP) and amniotic membrane are examples of regenerative medicine with applications in ankle and foot to include heel pain, tendonitis, arthritis, broken bones or fractures, wounds and ulcers etc. All of our doctors are trained in regenerative medicine and we offer this in office procedure to all our patients.
Rheumatology – Foot Care
Rheumatology refers to diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Some examples of rheumatologic disorders with manifestations in the ankle and foot are rheumatoid arthritis (RA), ankylosing spondylitis, gout, lupus etc. In fact, more than 90% of people with RA will experience symptoms in their feet or ankles. For about 20% of patients, RA symptoms first show up in their feet and ankles. Rheumatologic disorders can cause the ligaments in your ankle and foot to weaken and can cause the shape of your foot to change. In addition, these disorders can also cause your bones to shift and alter the alignment leading to other structural abnormalities such as bunions and deformed toes known as hammertoes and claw toes. All these ankle and foot manifestations of rheumatologic conditions lead to pain, difficulty with walking and even standing. Nonsurgical and surgical treatment options offered by our expert physicians and surgeons can help you get back on your ankle and feet.
Second Opinions & Revisional Surgery
You may be referred to our office by your podiatrist or orthopedist for a second opinion or to be evaluated for specialized surgery. Dr. Nakra has extensive surgical training and experience in revision of failed surgeries, surgical misadventures and surgical correction of complicated deformities.
Specialized In-Office Testing
Our office offers the latest technology in testing the blood supply and nerve supply to your ankles and feet. Peripheral artery disease (P.A.D) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop P.A.D, your extremities — usually your legs — don’t receive enough blood flow. This causes leg pain when walking (intermittent claudication). P.A.D. also increases your risk of heart attack, stroke, and transient ischemic attack (“mini-stroke”). Our in-office painless testing for P.A.D. will provide you information regarding blood supply to your legs and our doctors will offer treatment options to slow or stop disease progress and reduce the risk of complications. We also perform in office painless nerve testing on patients with neurological symptoms such as burning, tingling, numbness etc. This helps us determine if you have any kind of nerve damage.
The ankle and foot are among the most common sites for both new and old injuries in athletes and other physically active individuals. When an injury to the foot or ankle occurs, athletes are limited in their abilities to run, jump, kick, and change directions. Thus, the treatment and rehabilitation of these injuries are crucial in returning athletes to full participation at full function. When managing injuries for the foot and ankle, all of the typical clinical considerations must be thought of (type of injury, severity, healing time, type and level of activity, etc.), but it is also important to consider other factors such as foot type, biomechanics, footwear worn during activity, and external supports such as bracing or taping. The foot is the base for our bodies – if rehabilitation and treatment is not managed properly, an injury to the foot or ankle can ultimately cause secondary injuries elsewhere up the chain.
Trauma Surgery of the Ankle and Foot
Our office has extended hours to accommodate the foot and ankle trauma referred to our office by existing patients and local hospitals. This includes broken bones in the foot and ankle such as ankle fractures, heel bone or calcaneal fractures, sprains and strains, motor vehicle accidents, fall from ladders etc. We offer the latest technology in evaluating these injuries and prompt medical intervention.
Total Ankle Replacement
When conservative methods of treatment fail to provide adequate relief, either an ankle fusion or arthroplasty (ankle replacement) may be considered. Ankle replacement is a surgical procedure to replace the damaged surfaces of the human ankle joint with prosthetic components. Some causes of damage are ankle sprains, arthritis caused by ankle surgery in the past, broken ankle bone or fracture, osteoarthritis and rheumatoid arthritis – all these can lead to pain and loss of movement of the ankle. Ankle replacement is becoming the treatment of choice for patients. The restoration of range of motion is the key feature in favor of ankle replacement.
Concierge Medicine/Medical Tourism
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