New Tightrope Procedure for Bunions

Dr. Vargas Performs New Tightrope Procedure for Bunions!!

This past week I, Dr. Marco A Vargas of Foot & Ankle Associates, performed a revolutionary procedure for bunions using a device called a tightrope. While the procedure has been around for several months now, I felt that there were enough positive outcomes reported in the podiatry literature to feel comfortable enough to perform the procedure on my own patients. What makes the procedure revolutionary is that patients’ recovery time is half of what it is with traditional bunion surgery and there is significantly less postoperative pain due to no bone cut and less swelling. There is also a significantly reduced risk of postoperative complications due to the fact that there is no bone cut. There is no doubt that this procedure represents a huge advancement in bunion surgery.

Traditionally, the bunion procedures I perform involve a bone cut to reposition the bone which is held together with a pin or a screw. Following the surgery, patients walk around in a cast boot for 4-6 weeks to allow for bone healing. At this time they are able to return to regular shoes; however, postoperative swelling due to the bone cut, fixation and immobilization may limit their shoe gear choices for several weeks more. Although pain is mild to moderate for the first few days, it is usually well controlled with pain medication and physical therapy.
With the new tightrope procedure patients experience a faster recovery, less pain and fewer complications. Patients are out of the cast boot and into regular shoes as soon as 3 weeks postoperative. Because there is no bone cut made to reposition the bone, there is less swelling which means less pain and more choices of shoe gear sooner. Finally, should there be any complications due to the tightrope procedure, it is easy to remove making the procedure completely reversible so that there is no permanent alteration or deformity of the foot structure.
While the tightrope procedure is not indicated in every type of bunion deformity, it can be performed in the vast majority. It represents a revolutionary change in bunion surgery and will allow more people to undergo bunion correction due to a faster recovery, less pain and fewer complications. This means fewer days missed at work or less down time with the kids – 2 of the main reasons many people avoid bunion correction.

Forget The Pain, Running Injuries Can Be Depressing!!

Earlier this year I treated a patient who ran the Houston Marathon and jumped right into training for the upcoming triathlon season the following week, against my advice, while nursing a painful case of posterior tibial tendon tendonitits. Unfortunately this approach eventually sidelined him and forced him to scrap the entire triathlon season in order to undergo surgery and recover from his injury. This eventually led to a major case of depression which far outlasted his recovery from injury and almost kept him out indefinitely.

By nature, athletes have an extremely high tolerance for pain and at times tend to view their injuries as a normal part of their training regimen often to the point of ignoring serious symptoms. Posterior tibial tendonitis is a common injury in runners usually resulting from chronic overpronation and overuse caused by the repetitive force and trauma asociated with overtraining. Symptoms usually begin as soreness along the inside of the ankle and/or arch when pushing off and can eventually lead to weakness and severe pain. Left untreated, it can progress to a tear which usually requires lengthy immobilization or surgical intervention causing a major delay in any training regimen. However, if the injury is caught early and treated aggressively, it can be done without any interruption or possibly a slight, brief alteration in the training schedule while avoiding a lengthy delay which can spoil any runner's plans.

In this particular case, my patient underwent approximately 8 weeks of physical therapy, anti inflammatories and forced rest. During this time he became discouraged, angry and unmotivated, even though I recommended cross training to maintain at least some level of fitness so that his return to running would not be so traumatic. He resisted the entire time and even admitted to feeling "worthless" at one point. Once he was pain free, he was still afraid to resume running for fear he would reinjure his foot and it would sideine him again.

About 3 months after stopping running completely to rehabilitate from his injury, he began cycling, swimming and using the elliptical machine gradually. More recently, he resumed running starting at a much reduced distance than where he left off, and he is starting to regain confidence and a sense of self worth.

He now realizes what caused his depression and I have no doubt that he will return stronger than ever. More importantly, I think the lesson he learned and one that all athletes should learn, particularly runners, is not to ignore any injury. No matter how small or insignificant you may think the injury is, it can become significant if it is not addressed early and aggressively. The resulting depression from the mental trauma of having something so meaningful and enjoyable taken away can lead to an even more prolonged layoff from which you may never fully recover, long after the injury has healed.

Running is my Prozac!

I read a quote today that really outlines how I feel about running's goal in my life so I figured I would share:

"The secret shared by women runners: running is not just physical exercise but a spiritual, mental, and emotional journey. " Taken from Runner's Gazette

Running has always been my stress relief, my Prozac, and my outlet. A time that is all mine with an audience of God and nature.....and a few peeps from time to time. I hate the treadmill because I don't get my daily dose of nature, critters, and fresh air. Thank God it's spring!

Run Happy!

Five Items Every Runner Should Have On Their Holiday Wish List

The holiday season is here yet again. With only a few weeks left before all the holiday madness begins it is time to start thinking about what to put on your holiday wish list for this year. If you are a runner or maybe just someone who will want to run off the extra holiday pounds below are 5 items that everyone will want to have on their list this year.

1) A new pair of running shoes - Let’s face it, running shoes tend to be one of those things many people push off replacing. Whether you are busy preparing for the holidays or if you are just really partial to one pair of running shoes, a new pair of shoes can really help to keep your feet and body injury free. Although experts vary on how often to replace a pair of shoes, a good standard to go by is to replace your shoes every 350 miles or six months, whichever comes sooner.

2) Moisture Wicking Socks - The best pair of shoes in the world won’t be nearly as beneficial without a good pair of moisture wicking socks. Although it may seem extreme to have to pay $5 for a pair of specialty socks when you can get a 5 pack of cotton socks for the same price, socks are one thing you don't want to skimp on. They help keep your feet and toes stay dry in order to prevent blisters from forming.

3) Nike Fit - I really have to hand it to Nike because the Nike Fit is an extremely helpful tool for runners of all skill levels. This device allows you to track your runs, pace, and states of each workout through a chip in your shoe that can later be downloaded on to your computer to monitor your runs. If Nike isn’t the right shoe for you, there are adapters you can purchase to use the technology with other brands of shoes.

4) Running Utility Belt - If you have ever run a long distance race then you have probably seen those people with the belts around their waist that have little pouches to held various items. This is a great item for people who are long distance runners. The belt is ideal to hold little bottles of water, gel food packs or even your keys or cell phone.

5) Road ID - Although this last item may seem a bit much it is one of those things that it is better to be safe than sorry. A Road ID is an identification bracelet that runners and cyclists wear in case of an emergency so they can be identified. Accidents happen every day between athletes and automobiles, Road ID is a simple way to protect yourself in case anything were to ever happen to you while you are out on a run.

With the holidays being right around the corner don't forget to add these 5 items to your wish list this year so that you can have the gear you need to run off all those extra holiday calories.
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Playing Sports Does Not Have to Mean Getting Hurt!

Sports Injuries of the Foot and Ankle

Sports injuries of the foot and ankle generally fall into one of two categories: (1) Acute/Traumatic Injuries which occur due to a sudden force, or impact, on the foot or ankle, and (2) Overuse Injuries which result from overuse, lack of proper rest, lack of proper warm-ups, or poor conditioning.

But playing sports does not have to mean getting hurt. Warming up adequately, training effectively, using proper equipment for your sport, and recognizing and addressing the early warning signs of injury can reduce your risk of aches and pains.


The following is a list of some of the most common sports-related injuries of the foot and ankle:

Baseball—blisters, ankle sprains, muscle strains, stress fractures

Basketball—ankle sprains, Achilles tendonitis

Bicycling—Achilles tendonitis, plantar fasciitis, blisters

Dance—ankle sprains, dancer's fracture, sesamoiditis, plantar fasciitis, metatarsalgia, Achilles tendonitis, trigger toe

Football—shin splints, ankle sprains, Achilles tendonitis, turf toe, blisters

Golf—plantar fasciitis, stress fractures, blisters

Running—ankle sprains, Achilles tendonitis, blisters, plantar fasciitis, IT band syndrome, patellofemoral pain syndrome, piriformis syndrome, shin splints, stress fractures, muscle cramps

Skiing/Snowboarding—frostbite, muscle strains, ankle sprains

Soccer—ankle sprains, Achilles tendonitis, IT band syndrome, muscle cramps, blisters, patellofemoral pain syndrome, plantar fasciitis, shin splints, stress fractures

Tennis—Achilles tendonitis, ankle sprains, IT band syndrome, Achilles tendon rupture, stress fractures

Volleyball—Achilles tendonitis, Achilles tendon rupture, ankle sprains

While it is impossible to prevent every injury, research suggests that injury rates could be reduced by 25% if athletes took appropriate preventative action, including the following: be in proper physical condition to play a sport, play by the rules of the sport, wear appropriate protective gear, rest, warm-up, and avoid playing when in pain or when tired.


Just a few extra words about running:


Running is one of the easiest ways for athletes to get injured. Running injuries are common and often affect the ankles and feet. The impact and stress of running is sometimes hard on the muscles and joints, especially if the early warning signs of an injury are ignored. The best way to avoid running injuries is to prevent them using tips such as these:
· Stretch, stretch, stretch!
· Wear Proper Footwear
· Replace Shoes as Needed
· Warm Up Properly
· Cross Train
· Avoid Overtraining
· Follow the Ten Percent Rule



A podiatrist can recommend the proper running shoe for your foot type. If you're not sure which shoe is right for you, consult your podiatrist.

The Nike Free Running Shoe

Nike has developed a line of shoes called the Nike Free that has become very popular among long distance runners, track and field athletes, and football and basketball players. Nike Free is unique because it has a special design incorporating new technology that simulates barefoot running mechanics while still wearing shoes. The goals that barefoot running technique strives to reach, and that Nike Free has adapted, is attempting to strengthen the intrinsic muscles of the foot and leg thus preventing long term injuries.

Although Nike Free has become popular among runners there are some important things to take into consideration when deciding to buy these shoes or not.

1) Versions - If you do a little research on the Nike Free you will come to find out that there are actually many different versions of this shoe. The Nike Free can be ordered on a scale of 10.0 to 3.0 with 10.0 being the most supportive shoe and the 3.0 being the least supportive and most similar to barefoot running.

2) Ease into the Shoes - If you have never done any barefoot running, or ran in any minimalist shoes that strive to achieve the same goal as Nike Free shoes, then it is important to ease your way into these shoes. It is recommended to start off running a mile in these shoes and then gradually increasing your distance based on your body’s response to the shoes.

3) They aren't for everyone - Although Nike is continuously trying to find ways to make small changes and adding versions to the Nike Free to allow the largest population of runners to use them, these shoes still aren't for everyone. If you don't run consistently, need extra-cushioned running shoes, or are prone to ankle sprains, I would not recommend these shoes to you. The Nike Free is really built for routine runners with no other major foot problems. Furthermore, barefoot-style running requires significant changes in running mechanics to be successful. If you run in these shoes just as you would in a structured running shoe, you will put yourself at risk for becoming injured.

Nike Free technology has really changed the face of running shoes, opening a whole new vision into what running shoes could do for your feet and body. Although these shoes are becoming increasingly more popular in the running community, these shoes simply aren't for everybody. Be sure to visit with your sports podiatrist who can help recommend the right shoe for you.

Should You Change The Way You Run For Greater Speed?

In one study quoted all over the internet, it was found that long-distance runners were faster if they used forefoot or midfoot strike patterns.  People were encouraged to speed up their running by changing the pattern of running.  Newer studies have made these findings less clear...

According to Joseph Hamill, PhD, a professor of kinesiology at the University of Massachusetts at Amherts, which found some mild differences to the running patterns.  They even found that midfoot running took slightly more energy than rearfoot running.  But even more importantly was the findings that midfoot or forefoot runners should not change their running patterns to rearfoot running, as it would not be as efficient.  It was recommended instead that you continue the natural pattern.  Let me explain:

- If you are a rearfoot runner or a midfoot or forefoot runner, you will get more benefit from adjusting your running efficiency by correction of your stride length and arm motion. 
- Correct shoegear to allow highest quality of running pattern will also increase efficiency. 
- I would agree with the findings of the study that it is "better to just do what's normal for you."

Run smart and run fast.  Just remember that you can do it the way your foot functions without learning a new way to run.