Foot doctor talks about bunion deformity (and new ways to fix the problem), neuropathy, diabetes and why you should wear running sneakers for casual wear even if you’re not a runner
By Chris Motola
Q: You’re relatively new to Buffalo Medical Group, yes?
A: I’ve been a podiatrist for five years. I did my residency in Erie, Pennsylvania. That was a three-year surgical residency. And then my first two years out in practice I joined a small private practice in Jamestown. Then the opportunity came about with Buffalo Medical Group. I was sort of ready for something new, so I joined Buffalo Medical Group in October.
Q: What attracted you to the group?
A: I really like that we have such a broad network of providers. It’s great not just for the patients — who get access to different specialties within the group — but it makes it easy for the providers to be able to discuss patients they have in common.
Q: Where do podiatrists fit into the mix of medical care now?
A: Podiatry has evolved quite a bit over the years. The training now involves a minimum of three years in surgical residency. A big component of our practice now is diabetic limb salvage. We see patients in a couple of the area hospitals for in-patient consults. So we’re taking care of patients with diabetes and peripheral vascular disease. So we’re doing a lot of complex wound care and working with other specialties. There’s some overlap with orthopedics in forefoot and rearfoot reconstructive surgery.
Q: What affects does diabetes have on the feet?
A: With diabetes the main things we see are loss of sensation in the feet. So something kind of innocuous, like having a small callous can develop to the point where it’s a wound on the bottom of the foot. With the neuropathy caused by diabetes, they don’t necessarily feel or notice that there’s a problem going on and don’t always mount an immune response like a non-diabetic person. It puts the patient at risk for wounds, infections and delayed healing. When severe enough, some infections require surgery and amputation. So our role as podiatrists is to educate our diabetic patients and address issues before they become more serious and dangerous.
Q: What kinds of interventions are you able to do?
A: One of the newer procedures our group offers is a bunion procedure, the lapiplasty bunionectomy. That involves a multidimensional correction of a bunion deformity. What’s novel about this surgery is that it allows the patient bear weight to the foot almost right away. This is in contrast to older methods where the patient would have to be off their foot, in a cast, for weeks to months. Because we’re able to let people walk right away, we’re seeing a much quicker return to normal activities.
Q: What causes bunions?
A: We don’t know exactly the reason, but there’s definitely a hereditary component. A lot of people with bunions have a family member who also has bunions. There are also some bio-mechanical theories that relate to pronation or hyper-mobility. It’s equally prevalent in both men and women, but women are more likely to have pain from them and seek help. That part mostly has to do with the types of shoes women tend to wear.
Q: So shoes aren’t a cause themselves?
A: No, that’s something that a lot of people used to say that turned out not to be very accurate. Shoes can exacerbate the problem by irritating the bunions, but it’s not something caused by the shoes themselves.
Q: What got you interested in podiatry?
A: I came from a medical family. My dad was an OB-GYN and my mom was a nurse, so I ended up exposed to a lot of specialties through their friends and colleagues. My mother got me interested in podiatry after she had a foot fracture. That put it on my radar. It’s an interesting field because so many disease processes can have a manifestation in the feet. Neuropathy and peripheral vascular disease can be early symptoms.
Q: When you’re talking about neuropathy, that’s not just diabetes, right?
A: Right, a lot of conditions can cause neuropathy. Diabetes is one of them, but it can also be due to problems in the lower back like disc herniation. People on certain drugs, particularly chemotherapy, can also develop neuropathy in their feet. So, it doesn’t always have to be diabetes, that’s just the most common cause for it that we see in podiatry.
Q: In terms of structural issues, at what point would you refer a patient to an orthopedist?
A: We work closely with our orthopedic colleagues, so if we ran into a complex deformity that required a major reconstruction more appropriate to orthopedics, we would refer out.
Q: What general advice would you give people for taking care of their feet?
A: Definitely investing in good, supportive shoes is important. One thing we’re seeing with COVID is that, with folks not leaving their houses as often, they’re walking around barefoot or in slippers for much of the day. So we’re seeing a lot of people complaining about generalized arch pain and fatigue. And a lot of that is from not having support. I usually recommend running sneakers for casual wear even if you’re not a runner. They tend to have the best support.
Lifelines
Name: Taylor Hoff, D.P.M.
Position: Podiatrist with Buffalo Medical Group
Hometown: Phoenix, Arizona
Education: Temple University
Affiliations: Millard Fillmore Suburban Hospital; South Buffalo Mercy Hospital
Organizations: American Board of Food and Ankle Surgery
Hobbies: Skiing, traveling