There’s an old myth that if the lesser toes on your foot are longer than the great toe, the person is supposed to be lucky… regardless of the truth of this myth, most people who have a longer second or lesser toes (toes 2 through 5) suffer with difficult task of finding shoes that fit and eventually developing structural deformities called hammertoes. The fact is that shoes aren’t made for optimal biomechanical control and fit to an individual’s foot. Thus, when a person inherits long lesser toes they end up getting smaller shoes in order to get a better fit for function.

Toes that are too long bunch up when wearing heels

When it came to correcting these problems, I couldn’t accept the status quo and continue providing my patients with old fashioned procedures that had long recovery times, unreliable results, and visible scars.

I decided to create a solution that didn’t involve extensive recovery and was painless with hidden incisions.  This vision emerged in 2004 as the revolutionary outpatient procedure that effectively shortened long lesser digits… The Perfect 10! Aesthetic Toe Shortening™.  This trademarked procedure is performed with cosmetic technique so there is no evidence of surgery when the surgical site has healed, but still takes into consideration all the important functional aspects of traditional hammertoe surgery. With the use of high tech internal fixation, we’re able to provide our patients with a result that is permanent, beautiful and involves a easy and short recovery.

Internal fixation with no wires sticking out after surgery

Imagine… no more toes hanging off the end of those open-toed shoes; or no more corns on the top of those toes because they have been hammered in closed shoes for years! This procedure differs significantly from the commonly performed hammertoe correction. Older techniques require wires that stick out to hold the toe during recovery which means keeping your feet dry for 4 to 6 weeks after surgery. These older techniques also have a high risk of infection during the recovery period and are often painful with a not-so-cosmetic result.

If toes are too long, they can also hang off the edge when you wear heels

Since the introduction of The Perfect 10! Aesthetic Toe Shortening™ in 2004, the press, media and patients have been buzzing about this remarkable and revolutionary surgery.  The 20 minute procedure can be performed under local anesthesia only and the patient can walk on the foot immediately.  The recovery is painless and the recovery period allows the patient to continue with their regular activities, and working (with the exception of getting the foot wet) for only 2 weeks.

By developing such a simple procedure, it was inevitable that eventually there would be imitators who try to capitalize on the words “Aesthetic Toe Shortening”. And although I consider imitation to be the sincerest form of flattery, ensuring the integrity of this procedure and the well being of my patients is very important to me.  That is why I encourage consultations with other doctors, and then with our practice.  I am confident you will experience the difference. With tried and true results and over 3500 procedures performed, there is only one place to go for the original aesthetic toe shortening… Beverly Hills Aesthetic Foot Surgery.

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Call our office to schedule a consultation and see how easy it is to have beautiful, pain-free toes again.

For years now, women have been subjected to wearing shoes that aren’t necessarily the best for their feet. History has shown with customs like chinese foot binding, that the well being of a woman’s foot has taken second priority to social norms and beauty.  When I first started practice, I dealt with this contradiction in philosophy.  As a foot surgeon, correcting deformities that cause pain was the basis of my training.  But as time went on, I realized that advising women not to wear high heeled shoes, was unrealistic.  This is because in the modern world, professional or formal attire requires a woman to wear high heeled shoes due to social norms and pressures.  This is unfortunate but true.

Rather than isolate my practice form the realities of what women endure in the professional world, I decided to create a procedure that addresses the problems that women face when wearing high heeled shoes.  One such problem is a wide foot.  Bunions and Tailor’s Bunions (smaller bunion on the outside of the foot) are often the cause of pain and constant grief for women that have to wear these kinds of shoes.

The Cinderella Procedure addresses this issue with a modern, pain free, and short recovery procedure. Like my Aesthetic Bunion Correction, the Cinderella Procedure allows most patients to walk right after the procedure and be ambulatory during the post-operative period. In most cases, patients are able to be back into high heels in 4 weeks. This is a remarkable improvement form the traditional method of correcting this problem that leaves patients non-weightbearing for up to 2 months in some instances!

This procedure was recently highlighted on the CBS show “The Doctors”.  You can watch a clip of the show here: http://www.thedoctorstv.com/main/procedure_list/133

Here is a before and after Xray of the patient from the show demonstrating the procedure at just 13 days post-op!

Cinderella Before Surgery

Cinderella After Surgery

The Aesthetic Toe Shortening™ procedure that I had developed in 2003 had attracted a lot of media attention, and I was consulting with patients from all over the country.  As the popularity of this procedure grew, we noticed an increase in consultations asking about toe lengthening.  You might ask “why would someone need or want to lengthen their toes?”  There are two basic answers for this.

Brachymetatarsia

The first condition is a congenital condition called Brachymetatarsia.  This condition is when one of the lesser metatarsals is shorter than the others, resulting a shorter toe.  Usually the toe itself is normal, but it sits deeper in the foot, appearing to be shorter.  There are numerous procedures available to correct this condition, however the new technique I developed provides patients with a post operative experience that is much shorter than the standard procedures available today.  The result is usually immediate and once the skin is healed, the patient is able to wear regular shoes.  And example of brachymetatarsia is shown in photo to the left.

The second condition that can cause a short toe is a poor surgical result from previous hammertoe surgery. A common procedure performed to correct hammertoes is called Arthroplasty.  This procedure involves removing a portion of the head of one of the bones in the hammertoe.  A pin or K-Wire is placed through the toe to provide stability while this toe heals from surgery.  The pin is left in the toe until a fibrous cap is developed in the empty space which usually takes 4 weeks.  Once the pin is removed, the toe is supposed to stay where the length the pin has kept it during the recovery phase.  The problem is that every person is different and is the fibrous cap has not formed, or is eroded after 4 weeks, the toe begins to contract and results in this unfortunate situation.

Short Toe Caused by Surgery

Correcting this problem is a challenge for most surgeons since the toe has already undergone surgery and has developed much scar tissue. The Aesthetic Toe Lengthening™ procedure allows patients to have reliable and cosmetic results in about two weeks.  Every toe is unique so each surgery is literally custom tailored to the patient with a custom manufactured implant for the toe to obtain the correct length.  This is a first in foot surgery and we are proud to offer it to our patients.

The end result of this innovative new procedure is an aesthetic appearance and reconstruction to the normal foot design.  Often times smaller parallel procedures like a toe shortening will complete the result and provide the patient with the most ideal appearance.

Click here for intra-operative photos of Aesthetic Toe Lengthening™.

Below is an example of Aesthetic Toe Lengthening on a short toe that was caused by surgery.  The patient had seen an Orthopedic Surgeon for hammertoes and a traditional arthroplasty was performed which left the toe with no support once the K-Wire (pin) was removed.  Within a few months, the patient’s toe began to contract, and left her with this result.  She consulted with many foot surgeons who sent her away with no solution.

After our consultation, we decided to pursue the custom built procedure and the results speak for themselves.  The 2nd toe was lengthened and the 3rd toe was shortened.  This gave the patient a normal “parabola” toe structure.  She is now wearing open toed shoes after not wearing them for 10 years!

Before Dr. Sadrieh

After Dr. Sadrieh

Bunion correction has been around since the beginning of Podiatric Surgery. Traditional techniques however involve long recovery time and are painful and leave the patient with a visible scar instead of the bunion.  In the recent years however, significant innovations by Dr. Sadrieh have advanced this procedure to provide patients with a permanent, easy recovery and beautiful procedure.

Bunions are silent problems, often laying dormant for decades without pain. This is an illusion however, since the mal-alignment of this joint leads to arthritis and wearing of the cartilage of the first metatarsal. This precious coating of cartilage cannot be repaired, so early intervention and preservation of the joint surface is an important part of an advanced progressive practice.

Conservative solutions to this structural problem only buy time and do not lead to a definitive solution. Surgical solutions usually involve difficult recovery periods with immobilization and less than aesthetic results. That’s why I set out to improve on the excellent techniques I was taught by my mentors.  I am proud to offer my patients the Aesthetic Bunion Correction procedure.  With this technique, my patients enjoy a painless, short recovery period that provides them with a beautiful and permanent result. Advanced technology utilizing Titanium Headless Screws and Plastic Surgical skin closure give patients the best results available today.  I redesigned the osteotomy (bone cut) so that the the ground reactive forces (force put on the foot by the ground when you stand or walk) work with the healing of the bone, and in effect assist the bone in the natural healing process.  This is different than the traditional osteotomies that risk dislocation and are opposing the ground reactive forces.

With the Aesthetic Bunion Correction, 80% of the bunions can be fixed with an easy, painless and aesthetically pleasing result.  But not all bunions are the same.  In some cases, the inter-metatarsal angle (IM°) may be so high that a correction at the head of the bone, like The Cinderella Procedure, would not be enough correction to provide the patient with a complete long lasting result.

The TightRope Procedure

In these cases, the surgeon usually has to either fuse the joint at the base of the first metatarsal (the Metatarso-cuneiform Joint) or perform a base osteotomy.  The disadvantage of these procedures is that they require long recovery periods that are non-weight bearing and require casting.  These conditions involve increased risks (infection, delayed or non-union) and usually result in less than optimal results.

That is why I always try to incorporate the newest techniques and technologies into my practice so my patients can expect the most reliable and aesthetically pleasing results.  One of these technologies the Mini TightRope by Arthrex.  This innovative little procedure uses a special suture material called fiberwire to bind the first and second metatarsals together.  Fiberwire is a new material made of a mesh and wire-like material that has a tensile strength far greater than metal. The thin suture material is actually stronger than the bones that it is repositioning.  In effect, we are creating a new permanent ligament that holds the first and second metatarsals together reducing the inter-metatarsal angle.

Combining this procedure with my Aesthetic Bunion Procedure, we are able to achieve reduction of IM angles up to 24° without the use of a cast or non-weight bearing!

Here are the basic steps involved in the Mini TightRope + Aesthetic Bunion Correction.

1. Dissection is carried to the fibular (lateral) sesamoid apparatus where the fibular sesamoidal ligament is resected to allow for repositioning of the sesamoids to the correct position.

2. The medial capsule is incised and the joint is exposed.  At this step the bump is removed and prepared for the next step.

3. The guide wire for the TightRope is placed from medial to lateral.  This is a critical step.  A surgeon who has little experience with the TightRope could attempt to place the guide wire in the correct position with more than one try, thus weakening the 2nd metatarsal and causing a possible fracture.

4. The Mini TightRope is carefully threaded through the guide hole that is drilled over the guide wire.

5. With care, the inter-metatarsal is reduced and the Mini TightRope is tied down and the excess fiberwire is cut out.  The correction is checked and we now move on to perform the Aesthetic Bunion Correction if necessary.

The procedure is simple and reliable and is used in many well respected institutions across the country like UCLA Medical Center.

The innovative combination of the Mini TightRope + the Aesthetic Bunion Correction that I pioneered gives my patients the edge that they need to have their bunions corrected without having a 2 month recovery period in a non-weight bearing cast.

Do you find yourself buying wider shoes to accommodate your bunion? Do you have pain after wearing your high heeled shoes for more than an hour?  The advanced Aesthetic Bunion Correction can provide you with a solution that liberates you from the pain and difficulties of this “Quiet Joint Killer”. Be athletic… Be comfortable… Be bold with your shoes! Ask my staff about a consultation and taking the first step to resolving this unsightly problem.

Having the chance to showcase some of our advanced procedures for America to see on national television is an honor.  With everything we do, kids matter most.  To do our best for our children, we can help prevent pathology by diagnosing problems early, and providing sophisticated solutions that prevent significant foot conditions.

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 included discussion about the possible manifestation of foot problems in your kids feet and have provided consultation for my patient’s kids for free as part of their own follow-up care.

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 is 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.

That is why I am proud to announce The Liber-archy Flat Foot Procedure™.  This procedure takes the most problematic foot structure (flat foot) and corrects it with a simple, out-patient procedure.  The idea behind the procedure is not that unlike what we do when we plant a sapling tree.  A small tree is flimsy and impressionable by the environment.  To prevent a bent or crooked tree, we tie these saplings to a stick, providing structural support until they are strong and rigid enough to stand upright on their own.

Kids feet are similar to little trees.  They too are very impressionable and made mostly of cartilage.  This cartilage eventually ossifies (solidifies) into bone.  The shape the bones in the foot take are therefore influenced by the forces that are exerted on the foot in the childhood ages.  If we were able to somehow control those forces, we could create a situation where the bones “solidified” in a more “normal”, rectus (correct) position… basically, we could mold out the flat foot.

The most common approach is orthotics (commonly called arch supports).  Orthotics are inserts that are custom fit to the feet and control the collapse of the arch.  The problem with orthotics is that they can be very costly, and since kids grow fast, they would need to be replaced twice or three times a year.  Another problem with orthotics is that they only work, if you wear them.  Kids nowadays are so active that losing or misplacing a pair of orthotics is a common and expensive mistake.

In the 70’s the Arthroeresis procedure was pioneered by a Podiatrist for correcting and preventing the problems associated with pediatric flatfoot.  This procedure has evolved over the years and has provided thousands of children a better way to control flat foot development and prevent foot pathology.  Flat feet are linked to bunions, hammertoes, arthritis, knee problems, lower back problems and a whole list of other orthopedics issues.  Preventing the development of flat feet is the single most important thing a Podiatrist can do for your kids.

I often hear from parents that “our Pediatrician said that they will grow out of the problem”.  This is not true.  Children will grow out of their Pediatrician, but they will grow “in-to” the problem.  As children develop, the flat foot condition will advance the Tibial and Femoral Torsion that occurs normally as the process of growth continues adapt to keep the knees pointed forward.  So the pronation is masked and the flat foot becomes a permanent fixture.

I have developed an updated Arthroeresis procedure… I call it the “Liber-archy”.  This procedure liberates the arch and frees it from the unfortunate destiny of becoming a painful flat foot with all of it’s other problems.  The Liber-archy takes into consideration all the risks and not only is performed in the safest, most advanced methods available today, but takes into consideration the finished appearance, and is performed with a minimally invasive, aesthetic approach that is unique to our practice.  This way, your children are not left with scars on their feet and a traumatic experience.

The goal is to place the bones of the foot in the ideal positions so that the forces that are exerted on them mimic a normal foot, and result in the “normal” adult foot.  The results speak for themselves.  You can watch this procedure on the recent episode of The Doctors that aired on May 21st, 2009.

Since the introduction of this procedure, there has been an overwhelming response from around the country.  Many patients have asked about an “adult” version of the procedure.  Of course, the premise of the Liber-Archy Flat Foot Procedure is to prevent future damage to the foot and influence the development of the pediatric foot to “normal”, however in certain cases adult intervention can be helpful.

Adult Subtalar Implant

The problem with Adult Subtalar Arthroeresis is that tolerating the implant in the Subtalar joint is not always a guarantee for adults.  The implant is also different.  The adult version of this procedure utilizes a titanium implant.  The procedure is still minimally invasive, however there are more factors to take into consideration before making the decision to do surgery.  Ultimately like most procedures, consultation with your surgeon is most important to get a comprehensive understanding of the options that are available for you.

Ever since the beginning of fashion, women have had to compromise comfort for beauty when it came to their feet. Women’s shoes and modern fashion aren’t always on the same page. Although fashion is fictional world made up by people, it is pervasive in almost every part of the modern woman’s world.

Xray of Foot in High Heeled Shoe

When I first started practicing, I gave recommendations based only on the academic world I was trained from.  But as time went on, I realized that although I was recommending that women change the shoes they wear to more responsible and Podiatrically correct types, women weren’t listening.  This was because in the real world, a woman is under pressures that the average male doesn’t experience.  Wearing a high heeled shoe is the “standard” attire for a professional woman, even if it’s a little one.  The high heeled shoe has become part of the day to day culture of being a woman, almost every woman I have met owns at least one pair of high heeled shoes.

So I realized that if I really wanted to help my patients, I would think outside the box and create solutions and treatments that prevented damage to women’s feet in the battlefield of fashion. The Foot-Tuck Fat Pad Augmentation™ is one those solutions.

When a woman wears a high heeled shoe, the anatomy is changed and the pressure is put on the heads of the metatarsals rather than the base where it is designed to be (shown in the picture above). This creates a slew of problems that I treat regularly.  Bunions and hammertoes are some of the more well known ones.  But most women will share the story of how “their heels killed them” after that night out, or how “I danced all night, but my feet paid for it the next day cause of my heels”.  This common problem is usually treated by most foot specialists by recommending better shoes.  Those same women, keep wearing their heels.

Where will shoe design go next?

The first treatments I started to offer used collagen injections or DermaFiller injections to the ball of the foot that would augment the fat pad found underneath the foot in the region often referred to as the “ball of the foot”. The metatarsal bones rest on this fat pad in the normal standing position. But when the foot is put into a high heeled shoe the position of the metatarsal heads and the fat pad changes. The fat pad is shifted backwards and metatarsal heads are then placed in a downward slope with the heads taking more weight-bearing than normal. This creates discomfort after a short time since their is less effective padding in this region now that the fat pad has been shifted backward.

The use of injectable collagen or DermaFillers provided women with a conservative, safe alternative to surgery for getting relief from this uncomfortable condition. Depending on the product that was, the results could last up to one year. Injectable collagens and DermaFillers have been used for many years in plastic surgery and have proven their safety.

The procedure was received so well that even the media wanted a piece of it.  Watch this clip from the Tyra Banks Show: http://www.beverlyhillsfootsurgery.com/tyra-banks-show/.

Professional women are forced to wear heels

DermaFillers weren’t good enough though. They were temporary, costly, and sometimes caused allergic reactions.  That’s why in late 2007, I developed The Foot-Tuck Fat Pad Augmentation™.  Collaborating with renowned plastic surgeons in Beverly Hills, the Fat Transfer to the ball of the foot is a reality.  This procedure differs significantly from the collagen augmentation of the foot because there is a high potential for the fat transplants to be permanent.  The collagen injections are temporary and with the use of the different products can be prolonged to as long as 18 months, but fat transfer provides the patient with a potentially permanent solution to difficulty wearing shoes with heels. Like all of my procedures, there is no down time and no pain. The procedure is performed with only local anesthesia, and only takes an hour.

It seems incredible that we live in a society that we do procedures to wear certain shoes, but until we can change the societal pressures of the high heeled shoe being the standard professional shoe gear for a woman, simple, safe solutions like the Foot-Tuck can relieve the pain that women have to deal with.

Nails can become traumatized in a variety of ways.  Direct trauma, fungal infection, and metabolic disease are only a few of the conditions that can effect your nails.  Until recently, treatment for nail problems has been limited.  Treating fungal infections has been advanced with oral medications like Lamisil, but treatment of chronic ingrown nails, or dystrophic nails (nails that don’t grow correctly) are not optimal.

Dr. Sadrieh has created a new approach to what is called Nail Reconstruction.  His approach involves an initial assessment of the condition, and a custom pathway and treatment plan that will address the condition providing the patient with the most optimal results available.  Patients that suffer from chronic ingrown nails, can now have a permanent solution without down time, or pain.  The procedure is aesthetic and the results are impressive.

Nails that have damaged with physical trauma also have options available to them.  It is important to assess the nail for a specific treatment plan that is tailored to that particular problem (considering every nail is different).  Once a plan has been made by Dr. Sadrieh, you can start the process of reconstructing the nail and grooming it’s growth over the next 6 months.

“Although the process is slow, and often long, it’s worth it.  Most patients have been told to live with the nail problem they have, but my philosophy is, if I can do a small procedure and follow up regularly for a long duration of time, we can resolve most of the pathology out there.”  Dr. Sadrieh

Contact the office and let them know you are interested in nail reconstruction.  If you live far from the office, you may be able to email digital photos of your nails to Dr. Sadrieh for initial evaluation and a go ahead for in person consultation.