Surgery of the Foot and Ankle

Dr. Vladimir Zeetser is a board certified podiatric physician and surgeon specializing in reconstructive foot and ankle surgery.  He is certified by the American Board of Podiatric Surgery both in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery.  His training includes advanced wound management and limb salvage and he has consistently achieved unparalleled results in healing problematic wounds.  As an innovator and trendsetter in his field, he has been progressive in expanding aesthetic foot surgery and associated procedures to improve his patients' self-image while achieving among the highest functional outcomes and levels of patient satisfaction.  Apparently unconventional in his practice approach, Dr. Zeetser believes that surgery should be minimally painful with a convenient and tolerable recovery, while producing the maximum results.  He believes that the aesthetic result of any procedure is not a secondary consideration, but is just as important as the primary condition being corrected.

Feel free to explore this internet destination to become acquainted with the information and services available. Dr. Zeetser treats all aspects of foot and ankle structural disorders, including lower extremity muscular, neurological, vascular and skin conditions. During your consultation, Dr. Zeetser always performs a thorough evaluation, explains his findings in detail and creates a treatment plan tailored to your specific needs. With all of your options presented in an understandable manner, you participate equally in the decision making for the treatment of your complaint.

Advanced Modified Mini-TightRope Bunion Surgery

The treatment of hallux valgus deformity includes the assessment of the hallux valgus angle, the intermetatarsal angle and the contribution of an interphalageus deformity. Additionally, there must be an assessment of the presence or absence of arthritic involvement of both the first metatarsocuneiform joint and the first metatarsophalangeal joint. Other considerations are the orientation of the distal metatarsal articular angle and the orientation and stability of the first metatarsocuneiform joint.

Various methods have been described to correct the intermetatarsal angle. Soft tissue correction can be achieved by suturing the lateral capsule of the first metatarsal to the medial capsule of the second metatarsal, incorporating the intervening, previously released adductor tendon. A loss of reduction can occur due to the forces that oppose the suture repair as well as the possibility that poor tissue quality can contribute to a loss of reduction.

In the presence of more rigid deformities the intermetatarsal angle is reduced by using a distal or proximal osteotomy of the first metatarsal. Such osteotomies can be tec hnically challenging. A rather daunting list of consequences and potential complications include delayed union, malunion, nonunion, excessive shortening of the first metatarsal, avascular necrosis, hardware failure and prolonged protected ambulation.

The Mini TightRope is useful as an alternative and adjunct method for reduction of the intermetatarsal angle. A FiberWire® and button construct is placed across (distally or proximally) the first and second metatarsals. As the FiberWire is tightened, the intermetatarsal angle is reduced to a normal angle (less than 9-11°) The suture tied over the lateral button maintains a secure reduction of the intermetatarsal angle. Used alone or in conjunction with the distal soft tissue intermetatarsal repair, this technique affords a greater degree of strength and security than can be achieved with the soft tissue repair alone. Additionally, the Mini TightRope System provides a more technically straightforward method of reducing and maintaining the intermetatarsal angle than with conventional osteotomies while avoiding the complications associated with osteotomies.

Botox injections for excessive foot sweating

Excessive sweating (hyperhidrosis) of the plantar aspect of the feet is a common problem affected many people. Besides being an uncomfortable hygienic condition, contributing to fungal infection and Athlete's foot, it can be an equally embarrassing problem creating social and psychological concerns. Botox injections for the bottom of the feet is a relatively new concept, but conforms well to the general increased awareness for aesthetic and hygienic concerns affecting daily life. Previously used safely in the foot for the treatment of spastic muscular conditions, such as in the Achilles tendon for spastic Cerebral palsy, Botox (botulinum toxin type A) has been used by plastic and aesthetic physicians for many years. In 2004, the FDA approved Botox for the treatment of excessive sweating. When topical antiperspirants and other drying agents are ineffective, Botox has been used as a safe and effective method for the treatment of excessive sweating in the bottom of the feet. Its mechanism of action is to temporarily block the secretion of the chemical responsible for activating sweat glands and thus interrupts sweating at the area where is has been injected.

Dr. Zeetser can administer these injections in the office following a local anesthetic injection to numb the bottom of the foot. Many other physicians performing this procedure rely on topical creams or ice to numb the area, which is not sufficiently effective on the foot. The procedure is relatively quick and painless once anesthesia has been achieved. After the procedure, there is no significant restriction to activities. Mild temporary bruising and tenderness can occur. Nothing can completely cure hyperhidrosis and this procedure is designed to control the condition. Sweating may return gradually on average within 6 months. Further injections may be required to maintain the desired effect at intervals varying between 7-16 months, depending on the individual patient.

Diabetic Foot Wounds

There are over than 21 million known people with diabetes in the United States, and this staggering figure continues to grow by almost one-half million annually. It has been estimated that an equal number of persons with diabetes remain undiagnosed. A person develops diabetes when their body is unable to maintain a normal level of sugar in the blood. Insulin, the hormone that regulates the level of sugar, is either not used properly by the body or it is produced in inadequate amounts. When this occurs, diabetes is the result.

Diabetes wreaks havoc with many major organ systems in the human body. Among others, it tends to create some of the worst and life altering complications in the feet. Over one half of diabetic hospital admissions are foot related. This is typically due to the disease process' effect on the nerves and blood vessels. As a result, the main complications include neuropathy (altered sensations which can eventually lead to numbness), peripheral arterial disease, increased risk of infection, decrease in tissue integrity and compromised healing capacity.

Flat Foot Deformity

This condition can be congenital or acquired and typically results in hyperpronation of the subtalar joint in the foot. A variety of other causes occur as well. Gradually, the medial arch collapses and the foot becomes progressively flatter. As the deformity continues, the shape of the foot is drastically altered and the bones, joints and soft tissue structures deteriorate. If caught early in life, this can be corrected with relatively simple surgical procedures such as a subtalar joint implant. Later in life, this becomes more difficult and more extensive surgery may be required. Conservative care typically consists of high quality custom foot orthotics.

Ankle Sprains

An ankle sprain is an injury to one or more ligaments to the ankle joint, usually on the outside (lateral aspect). These typically occur from twisting motions of the joint during a fall or from direct trauma. Early aggressive treatment typically yields the best results and fastest recovery. Ignoring the problem can lead to chronic ankle pain and a permanently weak and unstable ankle. Surgery is rarely indicated unless other associated injuries are sustained.