We’ve given a lot of thought to how we want our patients to experience their care.  Our practice has always focused on the patient experience as the prime directive of what drives the procedures we perform, the environment we create, and the protocols we follow.  Making sure our patients have an experience that is second to none is the primary tenet of our day to day operations.

When I made the decision to no longer pursue a new location in Beverly Hills, it was a significant crossroads for us. After all, I started my journey in this wonderful little city.  But as time has passed, the concept of Aesthetic Foot Surgery has evolved into a nationwide phenomenon.  Women (and men) from all over the country have visited us for cutting edge procedures.  Surgeons around the country have connected with us and learned the procedures and advanced their practices to incorporate this new way of looking at the patient… the comprehensive way.

So what’s next?  How do we take what we created, and make it even better. Well, that required a complete makeover.

I’m pleased to introduce you to the next generation of our practice, we call it evo.

A synthesis of technology, medicine and premium experience, evo is about setting the standard for excellence in care, and shifting the paradigm in patient access to support, information regarding their surgery and state of the art facilities and equipment.  We commit to provide our patients with the newest technologies available from Fuji CR high resolution imaging to Stryker RemB power, our patients can expect only the latest and the greatest.

The user experience is also part of the evo way.  Which is why later this month we will release out app, providing our patients with unparalleled access to their surgeon, post op information, as well as the practice.

We’re only getting started though.  2011 is the year of evo… we plan on releasing some pretty amazing technologies.  These are projects that I have committed the last 3 years to perfecting and are ready for our patients to experience.  We’re sure that these are game changers and that medicine will be a better place with the incorporation of evo technologies.

As always, thank you to every person who has traveled to our practice, from Celia down the street, to Lani from South Africa.  It’s an honor to be your foot surgeon.

As the sun sets on Beverly Hills Aesthetic Foot Surgery, the future is still very bright.  Evo will provide all the services our patients have come to expect from an innovative practice like ours, and more.  Enjoy…

evofoot.com

Foot surgery has always been reserved for those situations where pain is present.  This is a valid and important principle to adhere to when you are making a decision to treat a patient.  There are situations in medicine however, that warrant treatment before symptoms are present.  These are situations where we know that when the symptoms present, there may already be irreversible damage to the tissues.  One such presentation is in the foot.

Foot deformities such as bunions, hammertoes, wide feet and short toes can present with pain.  But this is usually the case after many years have past and the condition has manifested itself with secondary problems referred to as sequelae.  If you have a bunion deformity, and you have no pain; the chances are you will have pain in the future.  As we age, the surface of the joint where the bunion exists (the 1st metatarsal phalangeal joint) is slowly eroded away.  When the surface is void of cartilage and is exposed bone, DJD (degenerative joint disease) begins (a form or arthritis) and pain begins.  This process is usually inevitable with orthopedic conditions that have dislocation involved like bunions.

Preventing symptoms, and practicing with a proactive rather than a reactionary approach to foot problems, is one of the corner stones of my ideology in foot surgery.  Most procedures allow patients to be back to normal activities within 2 weeks and are permanent. Aesthetic results with minimally invasive incision technique and plastic surgical closure, is another critical component of this revolutionary surgical technique. Together these philosophies provide patients with the most advanced procedures available in Podiatric Surgery today.

To understand more about the tenets which define a real Aesthetic Foot Surgery practice, read my Practice Philosophy article here: http://www.beverlyhillsfootsurgery.com/practice-philosophy/.  Welcome to our site, and to taking the first step to your new feet.

I am a runner myself.  Running is a special sport because all you need are your shoes and you’re off.  The different conditions provide the runner with different challenges, without the need for extra equipment.  Running a big hill, or a long distance early in the morning are very different experiences.  But the common denominator with all the variations a runner can experience are the shoes.  Runners have to make sure that the shoes they buy are Podiatrically correct and provide their foot type with the best control and biomechanical support available.  If a runner’s shoes aren’t providing optimal support, a variety of functional problems can present, one of which is shin splints.

Most runners are familiar with shin splints; the pain and tenderness that occurs in the front of the lower legs that can be slow to heal. However, you don’t have to be a runner to have shin splits. Tibial shin splints are very common and affect both recreational and trained athletes.  The pain in the lower leg is caused by an overload on the shin bone and connective tissues. Shin splints may also cause mild swelling.  Athletes that engage in a lot of running or jumping are as risk for shin splints. You can also overload your shin bone by training too hard, too long or using improper training techniques.

What is the treatment for shin splits? The number one recommendation is rest. Although you do not have to give up your favorite sport, it is a good idea to switch to a lower impact sport such as swimming while your shin splints are healing. Other shin splint treatments may include applying ice and over-the-counter (OTC) pain relievers in the early stages. A foot and ankle specialist can help treat your shin splits by determining the cause of them.  It should be noted that shin splits are not a diagnosis but a description of symptoms that could be from several causes such as problems of the muscle, bone or the attachment of muscle to the bone. Therefore, it is important to visit your doctor for an examination. In addition, if your pain is persistent and does not respond to rest, you should call and schedule and appointment for consultation and evaluation.

Another issue that runners deal with is pronation.  Pronation is a term that describes the collapse and “outward” positioning of the heel in relation to the ground.  This happens with collapse of the structure called the Subtalar joint.  This is the joint that is directly under the ankle joint and connects the Talus (ankle bone) to the Calcaneus (heel bone).

An excellent video and graphic of pronation is in the August 2004 issue of Runner’s World.  The videos are here for you watch and understand.

Normal Pronation:  The outside part of the heel makes initial contact with the ground. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. The rolling in of the foot optimally distributes the forces of impact. This movement is called “pronation,” and it’s critical to proper shock absorption. At the end of the gait cycle, you push off evenly from the front of the foot.

Overpronation: As with the “normal pronation” sequence, the outside of the heel makes the initial ground contact. However, the foot rolls inward more than the ideal fifteen percent, which is called “overpronation.” This means the foot and ankle have problems stabilizing the body, and shock isn’t absorbed as efficiently. At the end of the gait cycle, the front of the foot pushes off the ground using mainly the big toe and second toe, which then must do all the work.

Underpronation: Again, the outside of the heel makes initial contact with the ground. But the inward movement of the foot occurs at less than fifteen percent (i.e., there is less rolling in than for those with normal or flat feet). Consequently, forces of impact are concentrated on a smaller area of the foot (the outside part), and are not distributed as efficiently. In the push-off phase, most of the work is done by the smaller toes on the outside of the foot.

Basically the foot is not functioning in the optimal position to transfer the motion forward.  So compensation occurs and joints suffer over time and slowly become arthritic.  It is important to prevent this from happening. Early intervention is very important! A simple visit and weight bearing xrays will diagnose the condition and begin the process of prevenative care that will provide you with years of happy healthy running.

Just remember, one more light pole!

Run for Life…

Infection control is one of the most important goals pre, intra and post operatively.  One of the driving forces behind the new new procedures I have developed over the past 9 years has been mitigation of surgical risk.  Many of these risks can be managed with advanced fixation techniques, new surgical techniques and sophisticated equipment.  But there is one risk factor that will always loom in every surgeons mind… infection.

Infection occurs because of bacterial colonization that exponentially replicates to levels that cause tissue damage and potentially dangerous bone infection.  To reduce this potential growth, surgeons employ many standard protocols.  Some of these include pre-operative scrub of the surgical site as well as the surgeon’s hands.  The use of autoclaved (sterilized) instrumentation and sterile operating room drapes and dressings is also standard procedure.

Post operative infection control is just as important.  This is achieved with oral antibiotics that inhibit bacterial growth while your skin is healing.  Once the skin has healed, the risk for infection decreases dramatically since the portal for infection has been closed.  This however is not the case for procedures that require fixation devices that pierce the skin (like K-Wires, External Fixators and such).  In these situations infection control must be continued until the hardware is removed and the entrance sites are healed.  This is also why all of the procedure I have designed have eliminated the need for external fixation.

But obtaining the holy grail in infection rate (< 1%) is a lot more challenging than that!  As part of our mission to provide the highest level care available in foot surgery, I have incorporated protocols that exceed the standards of most hospitals and surgery centers across the country, so we can meet this exceptional level of care.

Part of maintaining an excellent track record of infection free surgeries is exposing our facility to the demanding standards placed by the largest and most respected accrediting body in the country, the Joint Commission (commonly referred to as JCAHO).  This process requires that we maintain logs and implement infection control protocols that are mandated by the CDC (Centers for Disease Control) and WHO (World Health Organization).  JCAHO accreditation is the norm in most hospitals across the United States however, so I decided to “super-size” our protocols.

To achieve this lofty goal, I made a decision early in our practice to reduce the size of the patient flow as well as the staff in contact with maintaining these protocols.  This way instead of employing what’s found in most facilities (4+ people) in charge of instrument management, and sterilization processes, it’s just my surgical tech and myself. In this model there is tight control of what happens in preparation for each case and quality control can be micro managed.

Another simple factor is volume.  We’ve all learned the correlation between volume and quality: Q = 1/V.  As volume increases (the practice sees more patients per day) quality becomes compromised.  In a perfect world this can be circumvented, but unfortunately that isn’t a reality yet.  This is why we limit our patient volume so we can maintain the same level of excellence for every case.

I’ll discuss the relevance of a small volume practice in a future article and how it relates to our practice philosophy and ethos.

The surgical scrub has been shown to be one of the key components of infection control.  To increase your chances of success, in late 2009 I began to implement the “double scrub”.  With this protocol, we perform an initial pre-operative surgical scrub using Chlorhexidine Gluconate (Hibiclens).  This antiseptic has been shown effectivity against Gram positive as well as Gram negative microbes, and is the scrub of choice for most plastic surgeons.  Once the initial scrub is performed, the local anesthetic block is performed.  This prevents entrance of bacteria into the sterile compartments of the foot.  For more information on Hibiclens visit http://www.hibigeebies.com.

The second scrub is performed immediately before the procedure is performed.  This scrub utilizes DuraPrep by 3M.  DuraPrep has been shown to kill all major pathogens in one minute.  Keep in mind, this is performed after an thorough Hibiclens scrub so not many bugs are able to survive the first scrub, and if they do… we’ll knock them out with the second scrub!

Although this increases costs, my philosophy is how you we put a price on your well being?  You can learn more about DuraPrep here: http://solutions.3m.com

One of the things that always bothered me about hospital based surgeries is the known infection rates in hospitals.  Nosocomial infections (hospital bourn infections) have been discussed in almost every respected medical journal.  Long protocols and algorithms have been described to control this menacing and rapidly increasing phenomenon.

So how did we manage this problem?  It was simple… we invested in our own premium surgical facility, and restricted access to only non-infected patients.  This way, there just isn’t a chance that our O.R. can be contaminated with the scary bugs you hear about on the news.  It also allowed us to bypass the complex bureaucracy found in larger institutions and implement changes rapidly to benefit our patient population.

This is not to say that all hospitals are dirty environments.  Some of the finest facilities in the country like Cedars-Sinai medical center and UCLA hospital maintain some of the lowest infection rates, but the risk is still there since patients go in and out of these facilities with a variety of serious infections.

Having had the privilege of training in diabetic wound care and limb salvage at the Northridge Hospital Wound Care Center, I had a first hand experience of the rapidly growing field of wound care.  The technology in this area of medicine has evolved exponentially since I matriculated in my program.  One of the great yields of this science has been the use of Silver in wound management and infection control.  Silver has found it’s way into a variety of wound products.

As another first, in 2009 we began a universal protocol of using Maxorb Extra Ag+ dressings on EVERY surgical patient.  This advanced Calcium Alginate dressing not only absorbs drainage from the incisions keeping them dry (thus inhospitable to infection) but also delivers Silver ions to the incision site to kill any developing colonization process.  Once again, another expensive but important protocol we use to maintain our incredibly low infection rate.  You can read more about Maxorb Extra Ag+ here: http://www.medline.com/wound-skin-care/maxorb-extra-ag/

Steri-strips are used to further maintain the incision and reduce the tension so that the plastic surgical closure can heal without scarring.  When 3M released their antimicrobial steri-strips… it was a no brainer!

Even with all of the above measures, infection control has to be a top priority inside and after surgery.  That why every surgery is flushed with copious amounts of a Bacitracin Saline solution.  One of the simplest formulas for infection control is taught to every first year resident: “the solution to pollution, is dilution!”

After surgery, every patient is given oral antibiotics to manage bacterial growth.  Combine everything we’ve talked about with a pre-emptive first week dressing change, and we can proudly report a less than 1% infection rate for two years in a row!  Despite this achievement, part of our commitment to you is to continuously raise the bar and set the standard for modern foot surgery.

Dr. Ali Sadrieh

Summer is here, and the season for open toed shoes begins.  But this isn’t the best time for some women.  I meet these women everyday, and I feel privileged to be the doctor they choose to give them new feet.

When I decided to create what I consider a totally new mind set in foot surgery, I knew that I was going to open a new door in the medical treatment of foot problems.  In our modern society, medicine is still catching up with the idea of preventative surgical measures in the orthopedic realm.  As I have outlined in my practice philosophy statement, this is what I hope aesthetic foot surgery will grow into.  I consider it an honor to be part of this great shift in the moral paradigm of podiatry as we know it.

Every day, women come to our practice from around the United States, and now the world, telling me how they have been hoping there would be a doctor who would take them seriously about their long toes, or the discomfort they experience when they wear high heeled shoes at work.  The reality is that the modern woman is faced with social pressures than men do not experience.

A professional woman in the 21st century is expected to wear what is considered professional women’s shoes as acceptable attire.  What is sold to the modern woman by the fashion industry as beautiful, has some sort of a high heel.  The problem they face is that what is considered a professional, or sexy woman’s shoe is not consistent with what podiatric medicine considers orthopedically correct.

During the creation of my concept practice, Beverly Hills Aesthetic Foot Surgery, I decided to consolidate these two worlds and create a specialty that provided the modern woman, simpler, easy-recovery procedures that not only address the orthopedic problem that limits their shoe choices, but also does it with respect to the appearance of the finished result.

Today, I am proud to say that we see women from all over the world, and I have had the pleasure of being part of some amazing stories.  I have met women who had unfortunate results from old fashioned hammertoe surgeries who haven’t worn open toed shoes in 10 years, to CEOs who suffer with corns  because you can’t go to the board room in tennis shoes.

My commitment to continue innovating new solutions to my patients needs will always be the driving force or our practice, so I say, take of those sandals and feel how wonderful it is to experience the sand between your toes this summer… barefoot!

Dr. Ali Sadrieh

As you know, prevention is much more effective, and important than treatment.  If you prevent a problem, treating it in the future may not be necessary.  There is no scenario that adhering to this principle becomes more important than when we are treating our children or in Pediatric Medicine.  Podiatry has always focused on pediatric prevention.  In the 70′s the Arthroeresis procedure was pioneered by a Podiatrist for correcting and preventing the problems associated with pediatric flatfoot.  This was a minimally invasive procedure that effected the way the foot grew to prevent the development of future foot problems that would require more extensive surgery and cause other issues to develop.

Getting your little ones to the Podiatrist is just as important as having routine dental exams.  Diagnosing foot problems in kids can prevent surgery and treatment in their adult life.  I have always include discussion about possible manifestation of your diagnosis in your kids feet and provide consultation for my patient’s children as part of the follow-up care on your visit.

My thought is that if a doctor cares, he or she will always include in their discussion an invitation to examine the patient’s kids feet in the their upcoming visits.  This is consistent with the philosophy that if we catch things early, we can prevent them.  That is the premise of Aesthetic Foot Surgery, and a good doctor takes that concept and extends it to the next generation.

Children can present with early signs of all basic diagnoses.  Flat feet, bunions, warts and even hammertoes have all been described in children as young as five.  Providing you with the most advanced surgical techniques to correct foot problems has always been our goal, but remember to bring in your children for preventative diagnosis and treatment, so we can avoid surgery in the next generation.

Being outdoors in nature is one of the most healing activities you can participate in.  Human beings have always been outside, immersed in the beauty of nature.  But our world today is different.  We wear shoes; and we wear them almost everywhere we go.  So understanding the effect shoes have on your foot, and right fit of a good shoe is important.

This functional understanding of the foot is called Biomechanics.  What it provides a foot specialist is a way to describe how the foot functions based on the understanding of bone positions and ranges of motion.

Foot deformities can occur because of biomechanical imbalance.  When the foot is not operating correctly, various deformities such as bunions and hammertoes can develop which will need some sort of surgery if left unchecked.  Visiting our practice, we will use the most modern digital Xray technology to evaluate your foot structure, along with a thorough biomechanical evaluation.

With the assistance of sophisticated software (OsiriX) on  Apple iMac computers, we are able to reconstruct 3-D images of your MRI or CT scans to diagnose foot pathology like no other practice in Los Angeles.  The investment in digital Xray technology leaves a zero foot carbon footprint.  The computers are solar powered and the digital xrays require no actual xray film or folders so there is no paper or chemical usage.

With this advanced technology, giving you a comprehensive biomechanical diagnosis will help you spend more time barefoot without pain.  Our focus is to control your foot structure, so that you can enjoy that barefoot walk by the ocean without pain.